Provider Demographics
NPI:1295856995
Name:NORTHWEST CHIROPRACTIC AND THERAPY CENTER INC
Entity Type:Organization
Organization Name:NORTHWEST CHIROPRACTIC AND THERAPY CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-476-1700
Mailing Address - Street 1:16211 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5522
Mailing Address - Country:US
Mailing Address - Phone:216-476-1700
Mailing Address - Fax:216-476-1701
Practice Address - Street 1:16211 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5522
Practice Address - Country:US
Practice Address - Phone:216-476-1700
Practice Address - Fax:216-476-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
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=========-00OtherOH BUREAU OF WORKERS COMP