Provider Demographics
NPI:1972647097
Name:BURY CHIROPRACTIC AND WELLNESS CENTER
Entity Type:Organization
Organization Name:BURY CHIROPRACTIC AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-702-5555
Mailing Address - Street 1:4030 BOARDMAN CANFIELD RD
Mailing Address - Street 2:SUITE # 100C
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9505
Mailing Address - Country:US
Mailing Address - Phone:330-702-5555
Mailing Address - Fax:330-702-0363
Practice Address - Street 1:4030 BOARDMAN CANFIELD RD
Practice Address - Street 2:SUITE # 100C
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9505
Practice Address - Country:US
Practice Address - Phone:330-702-5555
Practice Address - Fax:330-702-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2292933Medicaid
OH2292933Medicaid
0896921Medicare ID - Type UnspecifiedGROUP MEDICARE #