Provider Demographics
NPI:1760523682
Name:LACOMBE CHIROPRACTIC & WELLNESS
Entity Type:Organization
Organization Name:LACOMBE CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BERRING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:503-503-3796
Mailing Address - Street 1:6024 S STATE ROUTE 48
Mailing Address - Street 2:
Mailing Address - City:MAINEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45039-8280
Mailing Address - Country:US
Mailing Address - Phone:513-494-0694
Mailing Address - Fax:513-494-0695
Practice Address - Street 1:6024 S STATE ROUTE 48
Practice Address - Street 2:
Practice Address - City:MAINEVILLE
Practice Address - State:OH
Practice Address - Zip Code:45039-8280
Practice Address - Country:US
Practice Address - Phone:513-494-0694
Practice Address - Fax:513-494-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3213111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2328038Medicaid
OH9353531Medicare ID - Type Unspecified
OH2328038Medicaid