Healthcare Provider Details

I. General information

NPI: 1144499880
Provider Name (Legal Business Name): GRACELAND CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7955 N HIGH ST
COLUMBUS OH
43235-1423
US

IV. Provider business mailing address

7955 N HIGH ST
COLUMBUS OH
43235-1423
US

V. Phone/Fax

Practice location:
  • Phone: 614-436-2225
  • Fax: 614-436-2220
Mailing address:
  • Phone: 614-436-2225
  • Fax: 614-436-2220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. DEAN ASHLEY HALDEMAN
Title or Position: OWNER, OPERATOR, PHYSICIAN
Credential: D.C.
Phone: 614-436-2225