Provider Demographics
NPI:1598062457
Name:GEORGE W. HEATHCOTE DC INC.
Entity Type:Organization
Organization Name:GEORGE W. HEATHCOTE DC INC.
Other - Org Name:ACTIVE CHIROPRACTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:HEATHCOTE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-839-8800
Mailing Address - Street 1:1 S MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-3225
Mailing Address - Country:US
Mailing Address - Phone:440-893-8800
Mailing Address - Fax:440-893-9422
Practice Address - Street 1:1 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-3225
Practice Address - Country:US
Practice Address - Phone:440-893-8800
Practice Address - Fax:440-893-9422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-11
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2725111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHHE0874281Medicare UPIN