Provider Demographics
NPI:1295893774
Name:EASTWOOD HEALTH AND WELLNESS CENTER INC
Entity type:Organization
Organization Name:EASTWOOD HEALTH AND WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAYNARD JR
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:740-687-0100
Mailing Address - Street 1:PO BOX 913
Mailing Address - Street 2:EASTWOOD HEALTH AND WELLNESS CENTER INC
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130
Mailing Address - Country:US
Mailing Address - Phone:740-687-0100
Mailing Address - Fax:740-687-0145
Practice Address - Street 1:422 NORTH COLUMBUS STREET
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130
Practice Address - Country:US
Practice Address - Phone:740-687-0100
Practice Address - Fax:740-687-0145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH506111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2283603Medicaid
OHDG4560OtherRR MEDICARE GROUP
OH0263530Medicaid
OH9318711Medicare PIN
OHDG4560OtherRR MEDICARE GROUP
OH4062991Medicare ID - Type UnspecifiedDR. MAYNARD MEDICARE