Provider Demographics
NPI:1528604139
Name:ACWC I
Entity Type:Organization
Organization Name:ACWC I
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KABIN
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:CARDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-235-3778
Mailing Address - Street 1:PO BOX 20770
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220-0770
Mailing Address - Country:US
Mailing Address - Phone:614-235-3778
Mailing Address - Fax:614-826-3450
Practice Address - Street 1:8878 COLERAIN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45251-2920
Practice Address - Country:US
Practice Address - Phone:614-235-3778
Practice Address - Fax:614-826-3450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0372266Medicaid