Provider Demographics
NPI:1841019551
Name:PRIME CHIROPRACTIC CENTER, LLC
Entity type:Organization
Organization Name:PRIME CHIROPRACTIC CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PART
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRANDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-930-6607
Mailing Address - Street 1:2735 N HOLLAND SYLVANIA RD STE B1
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1844
Mailing Address - Country:US
Mailing Address - Phone:419-930-6607
Mailing Address - Fax:419-517-4076
Practice Address - Street 1:2735 N HOLLAND SYLVANIA RD STE B1
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1844
Practice Address - Country:US
Practice Address - Phone:419-930-6607
Practice Address - Fax:419-517-4076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty