MEDICARE: SHAKER BOULEVARD REHAB GROUP 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

General Provider Information

NPI Number	:	1386052405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHAKER BOULEVARD REHAB GROUP LLC

Provider Business Mailing Address
First Line	:	11811 SHAKER BLVD STE 309
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1927
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11811 SHAKER BLVD STE 309
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44120-1927
Country	:	US
Telephone Number	:	216-791-4307
Fax Number	:	216-791-4338

Authorized Official
Title or Position	:	OWNER
Name	:	DREW SCHWARTZ
Credential	:
Telephone Number	:	216-791-4307

Provider Enumeration Date	:	08/01/2014
Last Update Date	:	08/01/2014

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