Provider Demographics
NPI:1275715211
Name:ABA FAMILY CHIROPRACTIC HOLISTIC HEALTH CENTER, LLC
Entity Type:Organization
Organization Name:ABA FAMILY CHIROPRACTIC HOLISTIC HEALTH CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:PICKENS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-535-7818
Mailing Address - Street 1:2439 N REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-2840
Mailing Address - Country:US
Mailing Address - Phone:419-535-7818
Mailing Address - Fax:
Practice Address - Street 1:2439 N REYNOLDS RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-2840
Practice Address - Country:US
Practice Address - Phone:419-535-7818
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-01
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1063111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9372771Medicare PIN