Provider Demographics
NPI:1477894046
Name:PREMIER HEALTH CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PREMIER HEALTH CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:
Authorized Official - Last Name:DILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-839-1055
Mailing Address - Street 1:6297 STATE ROUTE 303
Mailing Address - Street 2:
Mailing Address - City:WAKEMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44889-8209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6297 STATE ROUTE 303
Practice Address - Street 2:
Practice Address - City:WAKEMAN
Practice Address - State:OH
Practice Address - Zip Code:44889-8209
Practice Address - Country:US
Practice Address - Phone:440-839-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4362261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center