Provider Demographics
NPI:1467990168
Name:INDEPENDENCE ACCIDENT AND INJURY CENTER, LLC
Entity Type:Organization
Organization Name:INDEPENDENCE ACCIDENT AND INJURY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ROY
Authorized Official - Middle Name:
Authorized Official - Last Name:KORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-264-4327
Mailing Address - Street 1:3699 GARDEN CT
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-2906
Mailing Address - Country:US
Mailing Address - Phone:216-264-4327
Mailing Address - Fax:844-737-0784
Practice Address - Street 1:6701 ROCKSIDE RD
Practice Address - Street 2:SUITE 230
Practice Address - City:INDEPENDENCE
Practice Address - State:OH
Practice Address - Zip Code:44131-2358
Practice Address - Country:US
Practice Address - Phone:216-264-4327
Practice Address - Fax:844-737-0784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-02
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty