Provider Demographics
NPI:1417139064
Name:KAMMS CORNERS CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:KAMMS CORNERS CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WRONKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-251-9585
Mailing Address - Street 1:16806 LORAIN AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44111-5509
Mailing Address - Country:US
Mailing Address - Phone:216-251-9585
Mailing Address - Fax:216-251-9064
Practice Address - Street 1:16806 LORAIN AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44111-5509
Practice Address - Country:US
Practice Address - Phone:216-251-9585
Practice Address - Fax:216-251-9064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2616111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166356Medicaid
OH2166356Medicaid