Provider Demographics
NPI:1255797585
Name:DOLLISON CHIROPRACTIC OFFICE, LTD
Entity type:Organization
Organization Name:DOLLISON CHIROPRACTIC OFFICE, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:DOLLISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-439-9393
Mailing Address - Street 1:500 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-2854
Mailing Address - Country:US
Mailing Address - Phone:740-439-9393
Mailing Address - Fax:740-439-9395
Practice Address - Street 1:500 S 9TH ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-2854
Practice Address - Country:US
Practice Address - Phone:740-439-9393
Practice Address - Fax:740-439-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH1731111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0975388Medicaid
U49945Medicare UPIN