Provider Demographics
NPI:1649458332
Name:CENTRAL OHIO HEALTH & REHABILITATION ADVANCED CHIROPRACTIC P.C.
Entity type:Organization
Organization Name:CENTRAL OHIO HEALTH & REHABILITATION ADVANCED CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:NOVAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-321-1214
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-0397
Mailing Address - Country:US
Mailing Address - Phone:740-321-1214
Mailing Address - Fax:740-321-1264
Practice Address - Street 1:204 MUNSON ST
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1284
Practice Address - Country:US
Practice Address - Phone:740-321-1214
Practice Address - Fax:740-321-1264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-05
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2978111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9326471Medicare PIN