Provider Demographics
NPI:1811131626
Name:MONNIN UPPER CERVICAL CHIROPRACTIC
Entity type:Organization
Organization Name:MONNIN UPPER CERVICAL CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MONNIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-499-2356
Mailing Address - Street 1:105 W STATE ST
Mailing Address - Street 2:
Mailing Address - City:BOTKINS
Mailing Address - State:OH
Mailing Address - Zip Code:45306-8036
Mailing Address - Country:US
Mailing Address - Phone:937-894-0201
Mailing Address - Fax:937-894-0202
Practice Address - Street 1:105 W STATE ST
Practice Address - Street 2:
Practice Address - City:BOTKINS
Practice Address - State:OH
Practice Address - Zip Code:45306-8036
Practice Address - Country:US
Practice Address - Phone:937-894-0201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-23
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3971111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty