Provider Demographics
NPI:1699843979
Name:RICHLAND COUNTY CHIROPRACTIC CLINIC
Entity Type:Organization
Organization Name:RICHLAND COUNTY CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:VIERHELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-529-6024
Mailing Address - Street 1:1348 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1828
Mailing Address - Country:US
Mailing Address - Phone:419-529-6024
Mailing Address - Fax:419-529-6047
Practice Address - Street 1:1348 W 4TH ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1828
Practice Address - Country:US
Practice Address - Phone:419-529-6024
Practice Address - Fax:419-529-6047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3252111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2304152Medicaid
OH000000290929OtherANTHEM
OH282708957001OtherMEDICAL MUTUAL
OHVI4070102Medicare ID - Type Unspecified
OH2304152Medicaid