Provider Demographics
NPI:1346369295
Name:MT. LOOKOUT CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:MT. LOOKOUT CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-321-8484
Mailing Address - Street 1:455 DELTA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1127
Mailing Address - Country:US
Mailing Address - Phone:513-321-8484
Mailing Address - Fax:513-321-3676
Practice Address - Street 1:455 DELTA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45226-1127
Practice Address - Country:US
Practice Address - Phone:513-321-8484
Practice Address - Fax:513-321-3676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0687065Medicaid
OHC12019OtherRR MEDICARE GROUP NO.
OH0687065Medicaid