Provider Demographics
NPI:1437336385
Name:HEALTHWISE CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:HEALTHWISE CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEPTACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-494-7158
Mailing Address - Street 1:1170 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44720-4272
Mailing Address - Country:US
Mailing Address - Phone:330-494-7158
Mailing Address - Fax:
Practice Address - Street 1:1170 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH CANTON
Practice Address - State:OH
Practice Address - Zip Code:44720-4272
Practice Address - Country:US
Practice Address - Phone:330-494-7158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2010-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2311111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000140409OtherBLUE CROSS BLUE SHIELD
OH0239423Medicaid
OH299706158002OtherMEDICAL MUTUAL
OH000000140409OtherBLUE CROSS BLUE SHIELD
OHHE9331411Medicare PIN