Provider Demographics
NPI:1689612582
Name:HEALTH & WELLNESS CHIROPRACTIC REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:HEALTH & WELLNESS CHIROPRACTIC REHABILITATION CENTER, LLC
Other - Org Name:BOOHER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALISHA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOOHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-586-1060
Mailing Address - Street 1:38 COMMERCE PARK DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43082-7934
Mailing Address - Country:US
Mailing Address - Phone:614-586-1060
Mailing Address - Fax:614-586-1061
Practice Address - Street 1:38 COMMERCE PARK DR
Practice Address - Street 2:SUITE A
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-7934
Practice Address - Country:US
Practice Address - Phone:614-586-1060
Practice Address - Fax:614-586-1061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3261111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH379582Medicaid
9361701Medicare PIN