Provider Demographics
NPI:1407831423
Name:NASSIF, IVAN ALAN (DC)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:ALAN
Last Name:NASSIF
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 E COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-2729
Mailing Address - Country:US
Mailing Address - Phone:440-591-3881
Mailing Address - Fax:
Practice Address - Street 1:529 E WASHINGTON ST
Practice Address - Street 2:200 PARK PLACE
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4415
Practice Address - Country:US
Practice Address - Phone:440-247-5383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYX011151-1111N00000X
OH000135171100000X
OH3842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH9370921Medicare UPIN