Provider Demographics
NPI:1851788368
Name:CHIROPRACTIC CENTER OF NORTHFIELD LLC
Entity Type:Organization
Organization Name:CHIROPRACTIC CENTER OF NORTHFIELD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:EDMOND
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:330-467-6100
Mailing Address - Street 1:9309 OLDE 8 RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2060
Mailing Address - Country:US
Mailing Address - Phone:330-467-6100
Mailing Address - Fax:330-467-1792
Practice Address - Street 1:9309 OLDE 8 RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2060
Practice Address - Country:US
Practice Address - Phone:330-467-6100
Practice Address - Fax:330-467-1792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1215111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0582602 T48393OtherMEDICARE
OH0619898Medicaid