Provider Demographics
NPI:1891946513
Name:EAST TOLEDO CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:EAST TOLEDO CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:DOOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-693-0721
Mailing Address - Street 1:431 E BROADWAY ST
Mailing Address - Street 2:PO BOX 50618
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43605-2354
Mailing Address - Country:US
Mailing Address - Phone:419-693-0721
Mailing Address - Fax:419-693-9596
Practice Address - Street 1:431 E BROADWAY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43605-2354
Practice Address - Country:US
Practice Address - Phone:419-693-0721
Practice Address - Fax:419-693-9596
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RICHARD A. DOOM, D.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2719111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2090044Medicaid
OH2090044Medicaid