Provider Demographics
NPI:1881635829
Name:MID STATES CHIROPRACTIC OF EUCLID ROAD HEALTH CARE
Entity Type:Organization
Organization Name:MID STATES CHIROPRACTIC OF EUCLID ROAD HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-975-1777
Mailing Address - Street 1:34302 EUCLID AVE
Mailing Address - Street 2:SUITE #6
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-3334
Mailing Address - Country:US
Mailing Address - Phone:440-975-1777
Mailing Address - Fax:440-975-1770
Practice Address - Street 1:34302 EUCLID AVE
Practice Address - Street 2:SUITE #6
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-3334
Practice Address - Country:US
Practice Address - Phone:440-975-1777
Practice Address - Fax:440-975-1770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1689111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU01831Medicare UPIN
OHCO4019891Medicare ID - Type Unspecified