Provider Demographics
NPI:1508001793
Name:CORPORATE CHIROPRACTIC & MOBILE MEDICAL, INC.
Entity Type:Organization
Organization Name:CORPORATE CHIROPRACTIC & MOBILE MEDICAL, INC.
Other - Org Name:LUCENT PAIN RELIEF & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:VONGUNTEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-284-3646
Mailing Address - Street 1:4830 RIDGESIDE CIR SE
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44707-1133
Mailing Address - Country:US
Mailing Address - Phone:330-284-3646
Mailing Address - Fax:
Practice Address - Street 1:4830 RIDGESIDE CIR SE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44707-1133
Practice Address - Country:US
Practice Address - Phone:330-284-3646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC3695111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty