Provider Demographics
NPI:1881886604
Name:PANCHUR CHIROPRACTIC CORP
Entity type:Organization
Organization Name:PANCHUR CHIROPRACTIC CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:PANCHUR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-335-6070
Mailing Address - Street 1:1197 HIGH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-8282
Mailing Address - Country:US
Mailing Address - Phone:330-335-6070
Mailing Address - Fax:330-335-6080
Practice Address - Street 1:1197 HIGH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-8282
Practice Address - Country:US
Practice Address - Phone:330-335-6070
Practice Address - Fax:330-335-6080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2007-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2742111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA9354321Medicare PIN