Provider Demographics
NPI:1699223966
Name:RIVER'S EDGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:RIVER'S EDGE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SULLIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-459-1414
Mailing Address - Street 1:701 BETA DR
Mailing Address - Street 2:SUITE 18
Mailing Address - City:MAYFIELD VILLAGE
Mailing Address - State:OH
Mailing Address - Zip Code:44143-2367
Mailing Address - Country:US
Mailing Address - Phone:440-459-1414
Mailing Address - Fax:440-459-1347
Practice Address - Street 1:701 BETA DR
Practice Address - Street 2:SUITE 18
Practice Address - City:MAYFIELD VILLAGE
Practice Address - State:OH
Practice Address - Zip Code:44143-2367
Practice Address - Country:US
Practice Address - Phone:440-459-1414
Practice Address - Fax:440-459-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4186111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty