Provider Demographics
NPI:1902004310
Name:JACK D ADRIAN
Entity Type:Organization
Organization Name:JACK D ADRIAN
Other - Org Name:CLEAR CHOICE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:D
Authorized Official - Last Name:ADRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-339-5556
Mailing Address - Street 1:2850 S. COUNTY ROAD 25A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373
Mailing Address - Country:US
Mailing Address - Phone:937-339-5556
Mailing Address - Fax:937-339-5550
Practice Address - Street 1:2850 S. COUNTY ROAD 25A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373
Practice Address - Country:US
Practice Address - Phone:937-339-5556
Practice Address - Fax:937-339-5550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
OH912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0486871Medicaid
OHT47472Medicare UPIN
OH0486871Medicaid
0507674Medicare PIN