Provider Demographics
NPI:1356405385
Name:WESTLAKE CHIROPRACTIC, INC
Entity type:Organization
Organization Name:WESTLAKE CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:VALENTI
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:440-892-2207
Mailing Address - Street 1:27354 CENTER RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3957
Mailing Address - Country:US
Mailing Address - Phone:440-892-2207
Mailing Address - Fax:440-892-3475
Practice Address - Street 1:27354 CENTER RIDGE RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3957
Practice Address - Country:US
Practice Address - Phone:440-892-2207
Practice Address - Fax:440-892-3475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2216111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9276871Medicare PIN