Provider Demographics
NPI:1346318540
Name:POWELL CHIROPRACTIC INC
Entity Type:Organization
Organization Name:POWELL CHIROPRACTIC INC
Other - Org Name:CAMPUS VIEW CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:URBANEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC CHIROPRACTOR
Authorized Official - Phone:614-848-6022
Mailing Address - Street 1:71 E WILSON BRIDGE ROAD
Mailing Address - Street 2:SUITE 3A
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085
Mailing Address - Country:US
Mailing Address - Phone:614-848-6022
Mailing Address - Fax:614-848-5267
Practice Address - Street 1:71 E WILSON BRIDGE ROAD
Practice Address - Street 2:SUITE 3A
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-848-6022
Practice Address - Fax:614-848-5267
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2343146Medicaid
OH=========-00OtherOHIO BWC
OH2343146Medicaid