Provider Demographics
NPI:1720272784
Name:AULT CHIROPRACTIC
Entity Type:Organization
Organization Name:AULT CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:AULT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-519-6479
Mailing Address - Street 1:130 W STREETSBORO ST STE 2
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-2757
Mailing Address - Country:US
Mailing Address - Phone:330-342-0755
Mailing Address - Fax:
Practice Address - Street 1:130 W STREETSBORO ST STE 2
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-2757
Practice Address - Country:US
Practice Address - Phone:330-342-0755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-04
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3826 AND 3827111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty