Provider Demographics
NPI:1801918701
Name:TRICE CHIROPRACTIC CLINIC
Entity type:Organization
Organization Name:TRICE CHIROPRACTIC CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRICE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-428-2565
Mailing Address - Street 1:6227 N RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-2570
Mailing Address - Country:US
Mailing Address - Phone:440-428-2565
Mailing Address - Fax:440-417-0192
Practice Address - Street 1:6227 N RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-2570
Practice Address - Country:US
Practice Address - Phone:440-428-2565
Practice Address - Fax:440-417-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1466111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9311171Medicare ID - Type Unspecified