Provider Demographics
NPI:1669671509
Name:BUCKEYE CHIROPRACTIC AND REHAB INC
Entity Type:Organization
Organization Name:BUCKEYE CHIROPRACTIC AND REHAB INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:B
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-653-5390
Mailing Address - Street 1:1619 VICTOR RD NW
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-7883
Mailing Address - Country:US
Mailing Address - Phone:740-653-5390
Mailing Address - Fax:740-653-2808
Practice Address - Street 1:1619 VICTOR RD NW
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-7883
Practice Address - Country:US
Practice Address - Phone:740-653-5390
Practice Address - Fax:740-653-2808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-11
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1714111N00000X
OH001396225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188103Medicaid
OH0188103Medicaid
OHWA0792316Medicare PIN