MEDICARE: NORTHERN OHIO CHIROPRACTIC, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	2383	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194964833
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN OHIO CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	515 MOORE RD STE 4
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-2366
Country	:	US
Telephone Number	:	440-930-2338
Fax Number	:

Provider Business Practice Location Address
First Line	:	515 MOORE RD STE 4
Second Line	:
City	:	AVON LAKE
State	:	OH
Zip	:	44012-2366
Country	:	US
Telephone Number	:	440-930-2338
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. THOMAS J. PRZYBYSZ
Credential	:	D.C.
Telephone Number	:	440-930-2338

Provider Enumeration Date	:	02/19/2009
Last Update Date	:	02/19/2009

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