Provider Demographics
NPI:1295854669
Name:SOUTHEAST CHIROPRACTIC AND THERAPY CENTER INC
Entity Type:Organization
Organization Name:SOUTHEAST CHIROPRACTIC AND THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-514-9590
Mailing Address - Street 1:23131 EMERY RD
Mailing Address - Street 2:
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5136
Mailing Address - Country:US
Mailing Address - Phone:216-514-9590
Mailing Address - Fax:216-514-9592
Practice Address - Street 1:23131 EMERY RD
Practice Address - Street 2:
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5136
Practice Address - Country:US
Practice Address - Phone:216-514-9590
Practice Address - Fax:216-514-9592
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========7A00OtherBLUE CROSS BLUE SHIELD
OH=========-00OtherOHIO BUREAU OF WORKERS CO