Provider Demographics
NPI:1376655662
Name:CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:VAN SKYHOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-324-4488
Mailing Address - Street 1:42553 N RIDGE RD
Mailing Address - Street 2:SUITE 8
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1046
Mailing Address - Country:US
Mailing Address - Phone:440-324-4488
Mailing Address - Fax:440-324-2465
Practice Address - Street 1:42553 N RIDGE RD
Practice Address - Street 2:SUITE 8
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1046
Practice Address - Country:US
Practice Address - Phone:440-324-4488
Practice Address - Fax:440-324-2465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1467111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty