Provider Demographics
NPI:1386849842
Name:OHIO PIKE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:OHIO PIKE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:WEADICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-797-8262
Mailing Address - Street 1:1739 E OHIO PIKE
Mailing Address - Street 2:
Mailing Address - City:AMELIA
Mailing Address - State:OH
Mailing Address - Zip Code:45102-2007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1739 E OHIO PIKE
Practice Address - Street 2:
Practice Address - City:AMELIA
Practice Address - State:OH
Practice Address - Zip Code:45102-2007
Practice Address - Country:US
Practice Address - Phone:513-797-8262
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-15
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1654111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0889810Medicaid
OH15974Medicare UPIN
OHWE0684791Medicare ID - Type Unspecified
OHWE0684792Medicare PIN