Provider Demographics
NPI:1497094361
Name:CHRIS STYCHNO CHIROPRACTIC CENTER LLC
Entity Type:Organization
Organization Name:CHRIS STYCHNO CHIROPRACTIC CENTER LLC
Other - Org Name:CPS DIAGNOSTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/SOLE MBR
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:STYCHNO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:234-223-2921
Mailing Address - Street 1:716 PERKINSWOOD BLVD SE
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6228
Mailing Address - Country:US
Mailing Address - Phone:309-802-1783
Mailing Address - Fax:234-223-2258
Practice Address - Street 1:106 E MARKET ST STE 310
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44481-1151
Practice Address - Country:US
Practice Address - Phone:234-223-2921
Practice Address - Fax:234-223-2258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2020-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0109240Medicaid
OHH338810Medicare PIN