Provider Demographics
NPI:1952514754
Name:PLEASANT VALLEY CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:PLEASANT VALLEY CHIROPRACTIC CLINIC, INC.
Other - Org Name:PLEASANT VALLEY CHIROPRACTIC CLINIC, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:OTTO
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCHMIDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:216-520-6880
Mailing Address - Street 1:7664 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6746
Mailing Address - Country:US
Mailing Address - Phone:216-520-6880
Mailing Address - Fax:216-520-6885
Practice Address - Street 1:7664 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44134-6746
Practice Address - Country:US
Practice Address - Phone:216-520-6880
Practice Address - Fax:216-520-6885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1815111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9272741Medicare PIN