Provider Demographics
NPI:1376620963
Name:ACCORDINO BUTCH CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:ACCORDINO BUTCH CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:BUTCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-296-5619
Mailing Address - Street 1:5940 NEW MILFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:RAVENNA
Mailing Address - State:OH
Mailing Address - Zip Code:44266
Mailing Address - Country:US
Mailing Address - Phone:330-296-5619
Mailing Address - Fax:330-296-1019
Practice Address - Street 1:5940 NEW MILFORD ROAD
Practice Address - Street 2:
Practice Address - City:RAVENNA
Practice Address - State:OH
Practice Address - Zip Code:44266
Practice Address - Country:US
Practice Address - Phone:330-296-5619
Practice Address - Fax:330-296-1019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AC9191963Medicare ID - Type Unspecified