Provider Demographics
NPI:1386002889
Name:RICHFIELD CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:RICHFIELD CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:CRAMER
Authorized Official - Last Name:DOMANICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-659-4955
Mailing Address - Street 1:4028 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9230
Mailing Address - Country:US
Mailing Address - Phone:330-659-4955
Mailing Address - Fax:330-659-6052
Practice Address - Street 1:4028 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9230
Practice Address - Country:US
Practice Address - Phone:330-659-4955
Practice Address - Fax:330-659-6052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH991111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0541382Medicaid
OH0541382Medicaid
OHT47975Medicare UPIN