Provider Demographics
NPI:1649462128
Name:CROSS COUNTY CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:CROSS COUNTY CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SAWICKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-984-5454
Mailing Address - Street 1:9201 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7750
Mailing Address - Country:US
Mailing Address - Phone:513-984-5454
Mailing Address - Fax:513-984-5722
Practice Address - Street 1:9201 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:OH
Practice Address - Zip Code:45242-7750
Practice Address - Country:US
Practice Address - Phone:513-984-5454
Practice Address - Fax:513-984-5722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-17
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1291111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2011932Medicaid
OH2011932Medicaid
OHU33646Medicare UPIN
OH2011932Medicaid