Provider Demographics
NPI:1831303288
Name:IRONTON PARK AVENUE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:IRONTON PARK AVENUE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-7108
Mailing Address - Street 1:901 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-1529
Mailing Address - Country:US
Mailing Address - Phone:740-532-8888
Mailing Address - Fax:740-532-1796
Practice Address - Street 1:901 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1529
Practice Address - Country:US
Practice Address - Phone:740-532-8888
Practice Address - Fax:740-532-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0052323Medicaid
OH9275211Medicare PIN