Provider Demographics
NPI:1508130469
Name:NORTH COAST CHIROPRACTIC
Entity Type:Organization
Organization Name:NORTH COAST CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:F
Authorized Official - Last Name:DEMARIA
Authorized Official - Suffix:
Authorized Official - Credentials:DC DABCO FASBE
Authorized Official - Phone:440-323-3840
Mailing Address - Street 1:362 E BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-5223
Mailing Address - Country:US
Mailing Address - Phone:440-323-3840
Mailing Address - Fax:440-323-1566
Practice Address - Street 1:362 E BRIDGE ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-5223
Practice Address - Country:US
Practice Address - Phone:440-323-3840
Practice Address - Fax:440-323-1566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH730111N00000X
OH4254111N00000X
OH4255111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0653118Medicaid
OH0653118Medicaid