Healthcare Provider Details

I. General information

NPI: 1578517462
Provider Name (Legal Business Name): BRENT A UNGAR D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 07/05/2022
Certification Date: 07/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MUNSON ST NW STE B
CANTON OH
44718-2981
US

IV. Provider business mailing address

4200 MUNSON ST NW STE B
CANTON OH
44718-2981
US

V. Phone/Fax

Practice location:
  • Phone: 330-493-0009
  • Fax: 330-493-6659
Mailing address:
  • Phone: 330-493-0009
  • Fax: 330-493-6659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number1306
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1306
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: