Provider Demographics
NPI:1053990994
Name:BEDFORD CHIROPRACTIC & EFFECTIVE REHABILITATION
Entity type:Organization
Organization Name:BEDFORD CHIROPRACTIC & EFFECTIVE REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MUI JU
Authorized Official - Middle Name:
Authorized Official - Last Name:LIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-232-4325
Mailing Address - Street 1:690 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:OH
Mailing Address - Zip Code:44146-3642
Mailing Address - Country:US
Mailing Address - Phone:440-232-4325
Mailing Address - Fax:440-232-8691
Practice Address - Street 1:690 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:OH
Practice Address - Zip Code:44146-3642
Practice Address - Country:US
Practice Address - Phone:440-232-4325
Practice Address - Fax:440-232-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-07
Last Update Date:2021-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty