Provider Demographics
NPI:1609353630
Name:ASC WELLNESS LLC
Entity Type:Organization
Organization Name:ASC WELLNESS LLC
Other - Org Name:ADVANCED SPINAL CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:POLSINELLI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-461-9774
Mailing Address - Street 1:6501 WILSON MILLS RD STE B
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3442
Mailing Address - Country:US
Mailing Address - Phone:440-461-9774
Mailing Address - Fax:440-943-6716
Practice Address - Street 1:6501 WILSON MILLS RD STE B
Practice Address - Street 2:
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-3442
Practice Address - Country:US
Practice Address - Phone:440-461-9774
Practice Address - Fax:440-943-6716
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASC WELLNESS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-07-23
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH3327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH674460OtherMEDICARE - PTAN