Provider Demographics
NPI:1629287784
Name:VOLK'S CHIROPRACTIC ON VINE
Entity Type:Organization
Organization Name:VOLK'S CHIROPRACTIC ON VINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:VOLK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-946-9999
Mailing Address - Street 1:35011 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLOWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44095-5145
Mailing Address - Country:US
Mailing Address - Phone:440-946-8960
Mailing Address - Fax:
Practice Address - Street 1:35011 VINE ST
Practice Address - Street 2:
Practice Address - City:WILLOWICK
Practice Address - State:OH
Practice Address - Zip Code:44095-5145
Practice Address - Country:US
Practice Address - Phone:440-946-8960
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2753111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========-00OtherOHIO BWC