Provider Demographics
NPI:1760410336
Name:DAHODWALA, TY (DC)
Entity Type:Individual
Prefix:DR
First Name:TY
Middle Name:
Last Name:DAHODWALA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:DR
Other - First Name:TAMIM
Other - Middle Name:
Other - Last Name:DAHODWALA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC
Mailing Address - Street 1:1730 W 25TH ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44113-3108
Mailing Address - Country:US
Mailing Address - Phone:216-685-9975
Mailing Address - Fax:216-685-9976
Practice Address - Street 1:1730 W 25TH ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44113-3108
Practice Address - Country:US
Practice Address - Phone:216-685-9975
Practice Address - Fax:216-685-9976
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3000111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000228478OtherANTHEM BCBS PROVIDER ID
OHF03000OtherAPEX PROVIDER ID
OHF03000OtherSUMMACARE ID
OH104952OtherKAISER ID
OH2319075Medicaid
OH104952OtherKAISER ID
OHF03000OtherSUMMACARE ID