Provider Demographics
NPI:1366692113
Name:ADVANCED CHIROPRACTIC AND RAHABILITATION, LLC
Entity Type:Organization
Organization Name:ADVANCED CHIROPRACTIC AND RAHABILITATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:TOTARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-726-7404
Mailing Address - Street 1:1315 BOARDMAN CANFIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4075
Mailing Address - Country:US
Mailing Address - Phone:330-726-7404
Mailing Address - Fax:330-726-9920
Practice Address - Street 1:1315 BOARDMAN CANFIELD RD STE 3
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4075
Practice Address - Country:US
Practice Address - Phone:330-726-7404
Practice Address - Fax:330-726-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-29
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3478111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAD9368361OtherMEDICARE PROVIDER NUMBER (PTAN)