Provider Demographics
NPI:1053533513
Name:MIDWEST CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:MIDWEST CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MANZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:614-847-9667
Mailing Address - Street 1:6104 HUNTLEY RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43229-1004
Mailing Address - Country:US
Mailing Address - Phone:614-847-9667
Mailing Address - Fax:614-847-9688
Practice Address - Street 1:6104 HUNTLEY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-1004
Practice Address - Country:US
Practice Address - Phone:614-847-9667
Practice Address - Fax:614-847-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1454111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH311274667-00OtherBWC PROVIDER NUMBER
OH9267451Medicare PIN