Provider Demographics
NPI:1396921540
Name:CHIROPRACTIC WELLNESS CENTER OF HUDSON INC
Entity type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF HUDSON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JODIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:IZZO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-656-1977
Mailing Address - Street 1:5111 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-5018
Mailing Address - Country:US
Mailing Address - Phone:330-656-1977
Mailing Address - Fax:
Practice Address - Street 1:5111 DARROW RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-5018
Practice Address - Country:US
Practice Address - Phone:330-656-2163
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-18
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH2882111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2136932Medicaid
OH2136932Medicaid