Provider Demographics
NPI:1346280179
Name:HILLIARD FAMILY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HILLIARD FAMILY CHIROPRACTIC LLC
Other - Org Name:CHIROPRACTIC AND PHYSICAL THERAPY CENTERS OF OHIO-HILLIARD CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-801-1307
Mailing Address - Street 1:3696 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:614-771-7500
Mailing Address - Fax:614-771-6999
Practice Address - Street 1:4492 CEMETERY RD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-1103
Practice Address - Country:US
Practice Address - Phone:614-771-7500
Practice Address - Fax:614-771-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3262111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2453607Medicare ID - Type Unspecified
BR4080702Medicare ID - Type Unspecified