Provider Demographics
NPI:1407942881
Name:BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION
Other - Org Name:WALDRON CHIROPRACTIC & WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:WALDRON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-637-2225
Mailing Address - Street 1:2852 CADWALLADER SONK RD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9411
Mailing Address - Country:US
Mailing Address - Phone:330-637-1256
Mailing Address - Fax:
Practice Address - Street 1:3030 STATE ROUTE 5
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9271
Practice Address - Country:US
Practice Address - Phone:330-637-2225
Practice Address - Fax:330-637-2226
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BELL FAMILY CHIROPRACTIC CLINIC PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-05
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2680111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2081518Medicaid
OH2081518Medicaid
OH0862062Medicare ID - Type UnspecifiedCHIROPRACTIC