Provider Demographics
NPI:1558315978
Name:PRINCIPLED PHYSICIANS & REHABILITATION CENTER OF HAMILTON
Entity Type:Organization
Organization Name:PRINCIPLED PHYSICIANS & REHABILITATION CENTER OF HAMILTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:M
Authorized Official - Last Name:POPA
Authorized Official - Suffix:III
Authorized Official - Credentials:DC
Authorized Official - Phone:513-887-9400
Mailing Address - Street 1:4083 PLEASANT AVE
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45015-1907
Mailing Address - Country:US
Mailing Address - Phone:513-887-9400
Mailing Address - Fax:513-887-7512
Practice Address - Street 1:4083 PLEASANT AVE
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45015-1907
Practice Address - Country:US
Practice Address - Phone:513-887-9400
Practice Address - Fax:513-887-7512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2006111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0966683Medicaid
OHPR9265971Medicare PIN