Provider Demographics
NPI:1821244583
Name:OHIO FAMILY AND SPORTS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:OHIO FAMILY AND SPORTS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:PRENGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-855-6999
Mailing Address - Street 1:153 W MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9224
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:153 W MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9224
Practice Address - Country:US
Practice Address - Phone:614-855-6999
Practice Address - Fax:614-855-4365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3888111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty