Provider Demographics
NPI:1295095651
Name:OHIO SPORTS CHIROPRACTIC
Entity type:Organization
Organization Name:OHIO SPORTS CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEO
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KORMANIK
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:330-908-0203
Mailing Address - Street 1:148 E AURORA RD
Mailing Address - Street 2:
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-2053
Mailing Address - Country:US
Mailing Address - Phone:330-908-0203
Mailing Address - Fax:330-908-0204
Practice Address - Street 1:148 E AURORA RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-2053
Practice Address - Country:US
Practice Address - Phone:330-908-0203
Practice Address - Fax:330-908-0204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-20
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4178111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty