Provider Demographics
NPI:1801168596
Name:RICH CHIROPRACTIC CENTER, INC.
Entity type:Organization
Organization Name:RICH CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-855-7776
Mailing Address - Street 1:23285 STATE ROUTE 51 W
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:OH
Mailing Address - Zip Code:43430-1042
Mailing Address - Country:US
Mailing Address - Phone:419-855-7776
Mailing Address - Fax:
Practice Address - Street 1:23285 STATE ROUTE 51 W
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:OH
Practice Address - Zip Code:43430-1042
Practice Address - Country:US
Practice Address - Phone:419-855-7776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1375111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1417989575OtherINDIVIDUAL NPI
OH350033140OtherRAILROAD MEDICARE
OH1417989575OtherINDIVIDUAL NPI
OHRI0614973Medicare PIN