Provider Demographics
NPI:1861662330
Name:COURTHOUSE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COURTHOUSE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-333-9000
Mailing Address - Street 1:1500 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON COURT HOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43160-1767
Mailing Address - Country:US
Mailing Address - Phone:740-333-9000
Mailing Address - Fax:740-333-1847
Practice Address - Street 1:1500 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON COURT HOUSE
Practice Address - State:OH
Practice Address - Zip Code:43160-1767
Practice Address - Country:US
Practice Address - Phone:740-333-9000
Practice Address - Fax:740-333-1847
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COURTHOUSE CHIROPRACTIC INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-11
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2976111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2263705Medicaid
OHCO9353541Medicare PIN