Healthcare Provider Details

I. General information

NPI: 1982933032
Provider Name (Legal Business Name): DAYTON CHIRO & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 12/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8940 KINGSRIDGE DR
DAYTON OH
45458-1632
US

IV. Provider business mailing address

8940 KINGSRIDGE DR
DAYTON OH
45458-1632
US

V. Phone/Fax

Practice location:
  • Phone: 937-567-7888
  • Fax: 937-281-0666
Mailing address:
  • Phone: 937-567-7888
  • Fax: 937-281-0666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1602
License Number StateOH

VIII. Authorized Official

Name: DR. BRIAN W JOHNSON
Title or Position: OWNER
Credential: D.C.
Phone: 937-567-7888