Provider Demographics
NPI:1518272608
Name:OHIO PAIN AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:OHIO PAIN AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KOSTOGLOU
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-702-1677
Mailing Address - Street 1:6479 S RACCOON RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9270
Mailing Address - Country:US
Mailing Address - Phone:330-702-1677
Mailing Address - Fax:330-702-1679
Practice Address - Street 1:6479 S RACCOON RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9270
Practice Address - Country:US
Practice Address - Phone:330-702-1677
Practice Address - Fax:330-702-1679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-12
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC1473111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty