Provider Demographics
NPI:1750468161
Name:NORTHEAST CHIROPRACTIC CLINIC INC.
Entity Type:Organization
Organization Name:NORTHEAST CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:OBI
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHINAKWE
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DAAPM, FABDA
Authorized Official - Phone:614-447-2030
Mailing Address - Street 1:3172 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43224-3604
Mailing Address - Country:US
Mailing Address - Phone:614-447-2030
Mailing Address - Fax:
Practice Address - Street 1:3172 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43224-3604
Practice Address - Country:US
Practice Address - Phone:614-447-2030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2091111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0993760Medicaid
OH9284121Medicare ID - Type Unspecified
OH0993760Medicaid