Provider Demographics
NPI:1972972495
Name:INNOVATIVE FAMILY WELLNESS LLC
Entity Type:Organization
Organization Name:INNOVATIVE FAMILY WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:C
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-726-3456
Mailing Address - Street 1:7000 SOUTH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-3644
Mailing Address - Country:US
Mailing Address - Phone:330-726-3456
Mailing Address - Fax:330-726-2858
Practice Address - Street 1:7000 SOUTH AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-3644
Practice Address - Country:US
Practice Address - Phone:330-726-3456
Practice Address - Fax:330-726-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC.4332111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty