Healthcare Provider Details

I. General information

NPI: 1720260979
Provider Name (Legal Business Name): COOPERATIVE MEDICAL HEALTH CARE CORPORATION PROFESSIONAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2007
Last Update Date: 05/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 W. BAGLEY RD.
BEREA OH
44017
US

IV. Provider business mailing address

165 W. BAGLEY RD.
BEREA OH
44017
US

V. Phone/Fax

Practice location:
  • Phone: 440-826-1440
  • Fax: 440-826-1126
Mailing address:
  • Phone: 440-826-1440
  • Fax: 440-826-1126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number3639
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3521
License Number StateOH

VIII. Authorized Official

Name: DR. ERIC MACANGA
Title or Position: OFFICER
Credential: D.C.
Phone: 440-826-1440