Provider Demographics
NPI:1558408955
Name:MIDDLEBURG HEIGHTS CHIROPRACTIC OFFICE, INC.
Entity Type:Organization
Organization Name:MIDDLEBURG HEIGHTS CHIROPRACTIC OFFICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C.
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-886-4990
Mailing Address - Street 1:PO BOX 40450
Mailing Address - Street 2:
Mailing Address - City:BAY VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44140-0450
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:15350 BAGLEY RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-4824
Practice Address - Country:US
Practice Address - Phone:440-866-4990
Practice Address - Fax:440-866-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1139111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0610360Medicaid
OH9921451Medicare PIN
OH0610360Medicaid