Provider Demographics
NPI:1720516032
Name:SEVERIN, ERIC RAYMOND (DC)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RAYMOND
Last Name:SEVERIN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4028 BROADVIEW RD STE B
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44286-9230
Mailing Address - Country:US
Mailing Address - Phone:330-888-3543
Mailing Address - Fax:330-659-6052
Practice Address - Street 1:4028 BROADVIEW RD STE B
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44286-9230
Practice Address - Country:US
Practice Address - Phone:330-888-3543
Practice Address - Fax:330-659-6052
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2017-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1819111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor