Healthcare Provider Details

I. General information

NPI: 1437218492
Provider Name (Legal Business Name): MCBREARTY FAMILY & SPORT CHIROPRACTIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807 30TH ST NE
CANTON OH
44714-1404
US

IV. Provider business mailing address

807 30TH ST NE
CANTON OH
44714-1404
US

V. Phone/Fax

Practice location:
  • Phone: 330-491-0381
  • Fax: 330-491-0388
Mailing address:
  • Phone: 330-491-0381
  • Fax: 330-491-0388

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number3710
License Number StateOH

VIII. Authorized Official

Name: DR. PATRICK JOSEPH MCBREARTY
Title or Position: DOCTOR
Credential: D.C.
Phone: 330-491-0381