Healthcare Provider Details

I. General information

NPI: 1053990994
Provider Name (Legal Business Name): BEDFORD CHIROPRACTIC & EFFECTIVE REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2021
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 BROADWAY AVE
BEDFORD OH
44146-3642
US

IV. Provider business mailing address

690 BROADWAY AVE
BEDFORD OH
44146-3642
US

V. Phone/Fax

Practice location:
  • Phone: 440-232-4325
  • Fax: 440-232-8691
Mailing address:
  • Phone: 440-232-4325
  • Fax: 440-232-8691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: MUI JU LIE
Title or Position: MANAGER
Credential:
Phone: 440-232-4325