Provider Demographics
NPI:1982125993
Name:STAR CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:STAR CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-621-7555
Mailing Address - Street 1:1723 COLUMBUS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-3546
Mailing Address - Country:US
Mailing Address - Phone:419-621-7555
Mailing Address - Fax:419-621-5597
Practice Address - Street 1:1723 COLUMBUS AVE
Practice Address - Street 2:STE B
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870
Practice Address - Country:US
Practice Address - Phone:419-621-7555
Practice Address - Fax:419-621-5597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty