Provider Demographics
NPI:1740745777
Name:PREMIERE CHIROPRACTIC AND REHAB
Entity Type:Organization
Organization Name:PREMIERE CHIROPRACTIC AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-305-4813
Mailing Address - Street 1:1052 UPPER VALLEY PIKE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45504-4016
Mailing Address - Country:US
Mailing Address - Phone:419-305-4813
Mailing Address - Fax:
Practice Address - Street 1:1052 UPPER VALLEY PIKE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-4016
Practice Address - Country:US
Practice Address - Phone:419-305-4813
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty