Provider Demographics
NPI:1720276934
Name:MONROE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:MONROE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:YOUTSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DABCO
Authorized Official - Phone:513-539-9244
Mailing Address - Street 1:221 S MAIN ST
Mailing Address - Street 2:P.O. BOX 280
Mailing Address - City:MONROE
Mailing Address - State:OH
Mailing Address - Zip Code:45050-1330
Mailing Address - Country:US
Mailing Address - Phone:513-539-9244
Mailing Address - Fax:513-539-9246
Practice Address - Street 1:221 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:OH
Practice Address - Zip Code:45050-1330
Practice Address - Country:US
Practice Address - Phone:513-539-9244
Practice Address - Fax:513-539-9246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH897111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO9262411OtherMEDICARE GROUP #
YO0502972OtherMEDICARE INDIVIDUAL #
OHT47375Medicare UPIN