Provider Demographics
NPI:1598767212
Name:CANAL CHIROPRACTIC AND REHAB INC
Entity Type:Organization
Organization Name:CANAL CHIROPRACTIC AND REHAB INC
Other - Org Name:CANAL CHIROPRACTIC AND REHAB
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BARRY
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-833-0563
Mailing Address - Street 1:6790 THRUSH DR
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-8385
Mailing Address - Country:US
Mailing Address - Phone:614-833-0563
Mailing Address - Fax:614-833-0916
Practice Address - Street 1:6790 THRUSH DR
Practice Address - Street 2:
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-8385
Practice Address - Country:US
Practice Address - Phone:614-833-0563
Practice Address - Fax:614-833-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-12
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1955111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0930845Medicaid
OHU42011Medicare UPIN
OH0733261Medicare ID - Type Unspecified
OH0930845Medicaid