Provider Demographics
NPI:1306005756
Name:NECK BACK AND BODY ACCIDENT AND INJURY THERAPY CLINIC
Entity Type:Organization
Organization Name:NECK BACK AND BODY ACCIDENT AND INJURY THERAPY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COOWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVOUNAS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-941-1919
Mailing Address - Street 1:13357 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-3408
Mailing Address - Country:US
Mailing Address - Phone:216-941-1919
Mailing Address - Fax:216-941-2929
Practice Address - Street 1:13357 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-3408
Practice Address - Country:US
Practice Address - Phone:216-941-1919
Practice Address - Fax:216-941-2929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2545111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2058044Medicaid
OHKA0836681Medicare PIN