Provider Demographics
NPI:1578864286
Name:NORTHWEST OHIO CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NORTHWEST OHIO CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:GAULARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-636-5279
Mailing Address - Street 1:1304 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:OH
Mailing Address - Zip Code:43506-1544
Mailing Address - Country:US
Mailing Address - Phone:419-636-5279
Mailing Address - Fax:419-636-5805
Practice Address - Street 1:1304 W HIGH ST
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:OH
Practice Address - Zip Code:43506-1544
Practice Address - Country:US
Practice Address - Phone:419-636-5279
Practice Address - Fax:419-636-5805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-11
Last Update Date:2010-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH839111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0444488Medicaid
OH0489291Medicare PIN
OHT47231Medicare UPIN