Provider Demographics
NPI:1720260979
Name:COOPERATIVE MEDICAL HEALTH CARE CORPORATION PROFESSIONAL ASSOCIATION
Entity Type:Organization
Organization Name:COOPERATIVE MEDICAL HEALTH CARE CORPORATION PROFESSIONAL ASSOCIATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MACANGA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-826-1440
Mailing Address - Street 1:165 W. BAGLEY RD.
Mailing Address - Street 2:
Mailing Address - City:BEREA
Mailing Address - State:OH
Mailing Address - Zip Code:44017
Mailing Address - Country:US
Mailing Address - Phone:440-826-1440
Mailing Address - Fax:440-826-1126
Practice Address - Street 1:165 W. BAGLEY RD.
Practice Address - Street 2:
Practice Address - City:BEREA
Practice Address - State:OH
Practice Address - Zip Code:44017
Practice Address - Country:US
Practice Address - Phone:440-826-1440
Practice Address - Fax:440-826-1126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-29
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3521111N00000X
OH3639172M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No172M00000XOther Service ProvidersMechanotherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHV02252Medicare UPIN