Provider Demographics
NPI:1437227881
Name:CONCORD CHIROPRACTIC INC
Entity Type:Organization
Organization Name:CONCORD CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:LONCAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-354-6767
Mailing Address - Street 1:9841 JOHNNYCAKE RIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6729
Mailing Address - Country:US
Mailing Address - Phone:440-354-6767
Mailing Address - Fax:440-354-6919
Practice Address - Street 1:9841 JOHNNYCAKE RIDGE RD.
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6729
Practice Address - Country:US
Practice Address - Phone:440-354-6767
Practice Address - Fax:440-354-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2009-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1283111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4033022OtherMEDICARE INDIVIDUAL PIN
OH4033022OtherMEDICARE INDIVIDUAL PIN
OH9380471Medicare PIN