Provider Demographics
NPI:1487843769
Name:ALLIANCE CHIROPRACTIC CENTER, INC
Entity Type:Organization
Organization Name:ALLIANCE CHIROPRACTIC CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-235-8199
Mailing Address - Street 1:607 S HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43213-3176
Mailing Address - Country:US
Mailing Address - Phone:614-235-8199
Mailing Address - Fax:614-235-8646
Practice Address - Street 1:607 S HAMILTON RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213-3176
Practice Address - Country:US
Practice Address - Phone:614-235-8199
Practice Address - Fax:614-235-8646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2673111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2048304Medicaid
OHSP01931Medicare PIN
OH2048304Medicaid