Provider Demographics
NPI:1871650390
Name:ASSOCIATED CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:ASSOCIATED CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-719-6940
Mailing Address - Street 1:2996 STATE ROUTE 5
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORTLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44410-9203
Mailing Address - Country:US
Mailing Address - Phone:330-399-3046
Mailing Address - Fax:330-282-4306
Practice Address - Street 1:3008 STATE ROUTE 5
Practice Address - Street 2:SUITE B/C
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9203
Practice Address - Country:US
Practice Address - Phone:330-399-3046
Practice Address - Fax:330-282-4306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH602111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000130680OtherANTHEM
OH18436158900OtherBWC
OH0501380Medicaid