Provider Demographics
NPI:1013915875
Name:ALLIED CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:ALLIED CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DARREN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNODGROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-332-6840
Mailing Address - Street 1:1320 E STATE ST
Mailing Address - Street 2:SUITE 8
Mailing Address - City:FREMONT
Mailing Address - State:OH
Mailing Address - Zip Code:43420-4365
Mailing Address - Country:US
Mailing Address - Phone:419-332-6840
Mailing Address - Fax:419-332-6929
Practice Address - Street 1:1320 E STATE ST
Practice Address - Street 2:SUITE 8
Practice Address - City:FREMONT
Practice Address - State:OH
Practice Address - Zip Code:43420-4365
Practice Address - Country:US
Practice Address - Phone:419-332-6840
Practice Address - Fax:419-332-6929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2985111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2207632Medicaid
SN4146011Medicare ID - Type Unspecified