Provider Demographics
NPI:1568699775
Name:PARMATOWN SPINAL REHABILITATION CENTER INC
Entity Type:Organization
Organization Name:PARMATOWN SPINAL REHABILITATION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:ROMAN
Authorized Official - Last Name:FORTUNA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-888-4526
Mailing Address - Street 1:6900 RIDGE ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-0000
Mailing Address - Country:US
Mailing Address - Phone:440-888-4526
Mailing Address - Fax:440-888-9102
Practice Address - Street 1:6900 RIDGE ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-0000
Practice Address - Country:US
Practice Address - Phone:440-888-4526
Practice Address - Fax:440-888-9102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-15
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3343111N00000X, 261Q00000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty