Provider Demographics
NPI:1508221516
Name:KAISK COMMUNITY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:KAISK COMMUNITY CHIROPRACTIC, LLC
Other - Org Name:KAISK COMMUNITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAISK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-819-5116
Mailing Address - Street 1:1327 CANTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312-3948
Mailing Address - Country:US
Mailing Address - Phone:234-813-9200
Mailing Address - Fax:234-813-9201
Practice Address - Street 1:1327 CANTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44312-3948
Practice Address - Country:US
Practice Address - Phone:234-813-9200
Practice Address - Fax:234-813-9201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-17
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4583111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty