Provider Demographics
NPI:1629186283
Name:T L SAZDANOFF DC INC
Entity Type:Organization
Organization Name:T L SAZDANOFF DC INC
Other - Org Name:SAZDANOFF CHIROPRACTIC CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CA
Authorized Official - Prefix:MRS
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:WOLFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-756-6111
Mailing Address - Street 1:990 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-2246
Mailing Address - Country:US
Mailing Address - Phone:419-756-6111
Mailing Address - Fax:419-756-2549
Practice Address - Street 1:990 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2246
Practice Address - Country:US
Practice Address - Phone:419-756-6111
Practice Address - Fax:419-756-2549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH980111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherEIN
OHA40020Medicare UPIN
OH9294471Medicare PIN