Healthcare Provider Details

I. General information

NPI: 1427243757
Provider Name (Legal Business Name): CUYAHOGA CHIROPRACTIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2007
Last Update Date: 11/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14100 CEDAR RD SUITE 100
CLEVELAND OH
44121-3212
US

IV. Provider business mailing address

14100 CEDAR RD SUITE 100
CLEVELAND OH
44121-3212
US

V. Phone/Fax

Practice location:
  • Phone: 216-297-9779
  • Fax: 216-297-9810
Mailing address:
  • Phone: 216-297-9779
  • Fax: 216-297-9810

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3105
License Number StateOH

VIII. Authorized Official

Name: DR. JESSICA U SHELLEY
Title or Position: PRESIDENT
Credential: DC
Phone: 216-297-9779