Provider Demographics
NPI:1295873404
Name:CHIROPRACTIC ASSOCIATES OF WESTLAKE, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC ASSOCIATES OF WESTLAKE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.C
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COLETTO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-808-9840
Mailing Address - Street 1:842 CORPORATE WAY
Mailing Address - Street 2:SUITE 850
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-1537
Mailing Address - Country:US
Mailing Address - Phone:440-871-4700
Mailing Address - Fax:440-871-4702
Practice Address - Street 1:2750 DOVER CENTER RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4501
Practice Address - Country:US
Practice Address - Phone:440-808-9840
Practice Address - Fax:440-808-9862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-01
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2842111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU88502Medicare UPIN
OH4011711Medicare PIN