Provider Demographics
NPI:1447394705
Name:TOLEDO CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:TOLEDO CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MEMBER LLC
Authorized Official - Prefix:
Authorized Official - First Name:LORENE
Authorized Official - Middle Name:M
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-382-7400
Mailing Address - Street 1:743 S BYRNE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43609-1049
Mailing Address - Country:US
Mailing Address - Phone:419-382-7400
Mailing Address - Fax:419-382-9170
Practice Address - Street 1:743 S BYRNE RD
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43609-1049
Practice Address - Country:US
Practice Address - Phone:419-382-7400
Practice Address - Fax:419-382-9170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2017-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2322111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0279738Medicaid
OH4037511Medicare ID - Type Unspecified
OH0279738Medicaid
OH4037501Medicare ID - Type Unspecified
OHU82753Medicare UPIN