Provider Demographics
NPI:1417318981
Name:ALIGN CHIROPRACTIC ROCKY RIVER, LLC
Entity Type:Organization
Organization Name:ALIGN CHIROPRACTIC ROCKY RIVER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUYN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-767-5880
Mailing Address - Street 1:1236 SMITH CT
Mailing Address - Street 2:SUITE C
Mailing Address - City:ROCKY RIVER
Mailing Address - State:OH
Mailing Address - Zip Code:44116-1558
Mailing Address - Country:US
Mailing Address - Phone:216-767-5880
Mailing Address - Fax:216-767-5881
Practice Address - Street 1:1236 SMITH CT
Practice Address - Street 2:SUITE C
Practice Address - City:ROCKY RIVER
Practice Address - State:OH
Practice Address - Zip Code:44116-1557
Practice Address - Country:US
Practice Address - Phone:216-767-5880
Practice Address - Fax:216-767-5881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2060111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty