Provider Demographics
NPI:1245376227
Name:ESTADT CHIROPRACTIC CENTER INC
Entity type:Organization
Organization Name:ESTADT CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:ESTADT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-255-1315
Mailing Address - Street 1:9031 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6463
Mailing Address - Country:US
Mailing Address - Phone:440-255-1315
Mailing Address - Fax:440-255-5832
Practice Address - Street 1:9031 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6463
Practice Address - Country:US
Practice Address - Phone:440-255-1315
Practice Address - Fax:440-255-5832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty