Provider Demographics
NPI:1730301904
Name:HERITAGE CHIROPRACTIC HEALTH CENTER INC
Entity Type:Organization
Organization Name:HERITAGE CHIROPRACTIC HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-854-4544
Mailing Address - Street 1:2445 SOUTH LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614
Mailing Address - Country:US
Mailing Address - Phone:330-854-4544
Mailing Address - Fax:330-854-6571
Practice Address - Street 1:2445 SOUTH LOCUST ST
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614
Practice Address - Country:US
Practice Address - Phone:330-854-4544
Practice Address - Fax:330-854-6571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1298111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
350026356OtherMEDICARE PALMETTO GBA RAI
OH=========00OtherOHIO BUREAU OF WORKERS CO
350026356Medicare ID - Type Unspecified
OH=========00OtherOHIO BUREAU OF WORKERS CO
KN0621581Medicare ID - Type Unspecified