Provider Demographics
NPI:1316007123
Name:BLACK, DAVID C (DC)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:BLACK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 S. SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:BUCYRUS
Mailing Address - State:OH
Mailing Address - Zip Code:44820
Mailing Address - Country:US
Mailing Address - Phone:419-562-4242
Mailing Address - Fax:419-562-4979
Practice Address - Street 1:234 S. SANDUSKY AVE
Practice Address - Street 2:
Practice Address - City:BUCYRUS
Practice Address - State:OH
Practice Address - Zip Code:44820
Practice Address - Country:US
Practice Address - Phone:419-562-4242
Practice Address - Fax:419-562-4979
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2018-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1392111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0759415Medicaid
OHBLO667231Medicare ID - Type UnspecifiedMEDICARE NUMBER
OHU28144Medicare UPIN