Provider Demographics
NPI:1295095404
Name:ROLLING ACRES CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:ROLLING ACRES CHIROPRACTIC CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:AUCK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-745-8300
Mailing Address - Street 1:2537 ROMIG RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-3828
Mailing Address - Country:US
Mailing Address - Phone:330-745-8300
Mailing Address - Fax:330-745-8377
Practice Address - Street 1:2537 ROMIG RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-3828
Practice Address - Country:US
Practice Address - Phone:330-745-8300
Practice Address - Fax:330-745-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2015-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2111708Medicaid
OH0863133Medicare PIN