Provider Demographics
NPI:1851572663
Name:CHAGRIN CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:CHAGRIN CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHRISTIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-595-9999
Mailing Address - Street 1:27629 CHAGRIN BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4477
Mailing Address - Country:US
Mailing Address - Phone:216-595-9999
Mailing Address - Fax:216-595-0235
Practice Address - Street 1:27629 CHAGRIN BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4477
Practice Address - Country:US
Practice Address - Phone:216-595-9999
Practice Address - Fax:216-595-0235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC 1135111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9344661Medicare UPIN