Provider Demographics
NPI:1346725926
Name:BUCKEYE CHIROPRACTIC AND SPORTS INJURY LLC
Entity Type:Organization
Organization Name:BUCKEYE CHIROPRACTIC AND SPORTS INJURY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUERMIT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-791-1888
Mailing Address - Street 1:3116 W US HIGHWAY 22 AND 3 STE O
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8104
Mailing Address - Country:US
Mailing Address - Phone:513-791-1888
Mailing Address - Fax:513-984-4521
Practice Address - Street 1:3116 W US HIGHWAY 22 AND 3 STE O
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8104
Practice Address - Country:US
Practice Address - Phone:513-791-1888
Practice Address - Fax:513-984-4521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-28
Last Update Date:2018-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty