Provider Demographics
NPI:1700273125
Name:HEARST CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HEARST CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEARST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-292-0610
Mailing Address - Street 1:29425 CHAGRIN BLVD. SUITE 301
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-292-0610
Mailing Address - Fax:216-292-0627
Practice Address - Street 1:29425 CHAGRIN BLVD. SUITE 301
Practice Address - Street 2:
Practice Address - City:PEPPER PIKE
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-292-0610
Practice Address - Fax:216-292-0627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-23
Last Update Date:2015-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3575111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty