Provider Demographics
NPI:1184048621
Name:CANAL FULTON CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:CANAL FULTON CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHIFFLET
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-408-7550
Mailing Address - Street 1:2186 LOCUST ST S
Mailing Address - Street 2:
Mailing Address - City:CANAL FULTON
Mailing Address - State:OH
Mailing Address - Zip Code:44614-9468
Mailing Address - Country:US
Mailing Address - Phone:330-408-7550
Mailing Address - Fax:330-408-7560
Practice Address - Street 1:2186 LOCUST ST S
Practice Address - Street 2:
Practice Address - City:CANAL FULTON
Practice Address - State:OH
Practice Address - Zip Code:44614-9468
Practice Address - Country:US
Practice Address - Phone:330-408-7550
Practice Address - Fax:330-408-7560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4207111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty