Provider Demographics
NPI:1356591820
Name:SHREVE CHIROPRACTIC
Entity type:Organization
Organization Name:SHREVE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTIC ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-567-3996
Mailing Address - Street 1:PO BOX 545
Mailing Address - Street 2:126 W MCCONKEY ST.
Mailing Address - City:SHREVE
Mailing Address - State:OH
Mailing Address - Zip Code:44676-0545
Mailing Address - Country:US
Mailing Address - Phone:330-567-3996
Mailing Address - Fax:330-567-3996
Practice Address - Street 1:126 W MCCONKEY ST.
Practice Address - Street 2:
Practice Address - City:SHREVE
Practice Address - State:OH
Practice Address - Zip Code:44676-0545
Practice Address - Country:US
Practice Address - Phone:330-567-3996
Practice Address - Fax:330-567-3996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0888339Medicaid
OH4012491Medicare PIN
OH0888339Medicaid