Provider Demographics
NPI:1497219463
Name:330 CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:330 CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUIR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-953-1330
Mailing Address - Street 1:1280 BOARDMAN CANFIELD RD STE 1
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4073
Mailing Address - Country:US
Mailing Address - Phone:330-360-6264
Mailing Address - Fax:
Practice Address - Street 1:1280 BOARDMAN CANFIELD RD STE 1
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4073
Practice Address - Country:US
Practice Address - Phone:330-360-6264
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty