Provider Demographics
NPI:1710104005
Name:BEVINS & SCHORK CHIROPRACTIC CLINIC LTD
Entity Type:Organization
Organization Name:BEVINS & SCHORK CHIROPRACTIC CLINIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-941-4311
Mailing Address - Street 1:505 W EMMITT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WAVERLY
Mailing Address - State:OH
Mailing Address - Zip Code:45690-1083
Mailing Address - Country:US
Mailing Address - Phone:740-941-4311
Mailing Address - Fax:740-947-9884
Practice Address - Street 1:505 W EMMITT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:WAVERLY
Practice Address - State:OH
Practice Address - Zip Code:45690-1083
Practice Address - Country:US
Practice Address - Phone:740-941-4311
Practice Address - Fax:740-947-9884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1892 & 2609111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2256928Medicaid
OH2256928Medicaid