Provider Demographics
NPI:1356351464
Name:OXFORD MEDICAL HEALTH & WELLNESS CENTER LLC
Entity type:Organization
Organization Name:OXFORD MEDICAL HEALTH & WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STACY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHIDESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-524-4800
Mailing Address - Street 1:5144 COLLEGE CORNER PIKE
Mailing Address - Street 2:SUITE A
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-2129
Mailing Address - Country:US
Mailing Address - Phone:513-524-4800
Mailing Address - Fax:513-523-8631
Practice Address - Street 1:5144 COLLEGE CORNER PIKE
Practice Address - Street 2:SUITE A
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-2129
Practice Address - Country:US
Practice Address - Phone:513-524-4800
Practice Address - Fax:513-523-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH072432251S0007X
OH2292111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2251S0007XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistSportsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOX9307151Medicare PIN