Provider Demographics
NPI:1275922585
Name:FUNCTIONAL ENDOCRINOLOGY OF OHIO
Entity Type:Organization
Organization Name:FUNCTIONAL ENDOCRINOLOGY OF OHIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BOARDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-644-5488
Mailing Address - Street 1:2800 S ARLINGTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-4702
Mailing Address - Country:US
Mailing Address - Phone:330-644-5488
Mailing Address - Fax:330-644-9292
Practice Address - Street 1:2800 S ARLINGTON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-4702
Practice Address - Country:US
Practice Address - Phone:330-644-5488
Practice Address - Fax:330-644-9292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-10
Last Update Date:2015-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH00640111NN0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty