Healthcare Provider Details

I. General information

NPI: 1790337376
Provider Name (Legal Business Name): SOUTHWESTERN OHIO DISABILITY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2019
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8251 PINE RD STE 100
CINCINNATI OH
45236-2192
US

IV. Provider business mailing address

8251 PINE RD STE 100
CINCINNATI OH
45236-2192
US

V. Phone/Fax

Practice location:
  • Phone: 513-241-4230
  • Fax: 513-299-0542
Mailing address:
  • Phone: 513-241-4230
  • Fax: 513-299-0542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL HANCOCK
Title or Position: MANAGER
Credential: DC
Phone: 513-519-7021