Provider Demographics
NPI:1457530354
Name:VICTORY CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VICTORY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:PAMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-529-2703
Mailing Address - Street 1:1062 COMMERCE PKWY
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44805-8953
Mailing Address - Country:US
Mailing Address - Phone:419-281-1000
Mailing Address - Fax:419-281-2047
Practice Address - Street 1:1062 COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OH
Practice Address - Zip Code:44805-8953
Practice Address - Country:US
Practice Address - Phone:419-281-1000
Practice Address - Fax:419-281-2047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-26
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3669111N00000X
OH242111N00000X
OH2869111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty