Provider Demographics
NPI:1285815951
Name:FIRST CHOICE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FIRST CHOICE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:FONNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-418-7122
Mailing Address - Street 1:4303 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-1577
Mailing Address - Country:US
Mailing Address - Phone:614-418-7122
Mailing Address - Fax:614-418-7124
Practice Address - Street 1:4520 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43231-5854
Practice Address - Country:US
Practice Address - Phone:614-418-7122
Practice Address - Fax:614-418-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3599111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633216Medicaid
OH2633216Medicaid