Provider Demographics
NPI:1295990083
Name:PARMA FAMILY CHIROPRACTIC INC
Entity type:Organization
Organization Name:PARMA FAMILY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIEKLAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-661-6200
Mailing Address - Street 1:6166 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-3167
Mailing Address - Country:US
Mailing Address - Phone:216-661-6200
Mailing Address - Fax:216-661-7055
Practice Address - Street 1:6166 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-3167
Practice Address - Country:US
Practice Address - Phone:216-661-6200
Practice Address - Fax:216-661-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-22
Last Update Date:2013-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2731111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2106705Medicaid
OH1281458OtherBWC
OH2106705Medicaid