Provider Demographics
NPI:1528232139
Name:MAHOING VALLEY CHIROPRACTIC AND SPINAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:MAHOING VALLEY CHIROPRACTIC AND SPINAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:DESANTIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-729-9111
Mailing Address - Street 1:7747 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5726
Mailing Address - Country:US
Mailing Address - Phone:330-729-9111
Mailing Address - Fax:330-729-9015
Practice Address - Street 1:7747 SOUTH AVE
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5726
Practice Address - Country:US
Practice Address - Phone:330-729-9111
Practice Address - Fax:330-729-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center