Provider Demographics
NPI:1467622647
Name:ALDRICH CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:ALDRICH CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:D
Authorized Official - Last Name:ALDRICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-471-0018
Mailing Address - Street 1:100 N HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-2694
Mailing Address - Country:US
Mailing Address - Phone:614-471-0018
Mailing Address - Fax:614-471-5632
Practice Address - Street 1:100 N HAMILTON RD
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-2694
Practice Address - Country:US
Practice Address - Phone:614-471-0018
Practice Address - Fax:614-471-5632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2013-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1171111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0675738Medicaid
OHAL0603261Medicare PIN