Healthcare Provider Details

I. General information

NPI: 1013004514
Provider Name (Legal Business Name): BEAVERCREEK CHIROPRACTIC & INJURY TREATMENT CTR., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3060 DAYTON XENIA RD SUITE A
BEAVERCREEK OH
45434-6308
US

IV. Provider business mailing address

3060 DAYTON XENIA RD SUITE A
BEAVERCREEK OH
45434-6308
US

V. Phone/Fax

Practice location:
  • Phone: 937-427-2225
  • Fax: 937-431-1722
Mailing address:
  • Phone: 937-427-2225
  • Fax: 937-431-1722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2227
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006681
License Number StateOH

VIII. Authorized Official

Name: JULIE BLACK
Title or Position: OFFICE MANAGER
Credential:
Phone: 937-427-2225