Provider Demographics
NPI:1437697513
Name:TRI CHIROPRACTIC FAMILY & SPORTS MEDICINE, LLC
Entity Type:Organization
Organization Name:TRI CHIROPRACTIC FAMILY & SPORTS MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, CCEP
Authorized Official - Phone:937-404-2189
Mailing Address - Street 1:1175 LYONS RD BLDG E
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45458-1857
Mailing Address - Country:US
Mailing Address - Phone:937-404-2189
Mailing Address - Fax:937-569-4989
Practice Address - Street 1:1175 LYONS RD BLDG E
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45458-1857
Practice Address - Country:US
Practice Address - Phone:937-404-2189
Practice Address - Fax:937-569-4989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-08
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4656111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty