Healthcare Provider Details

I. General information

NPI: 1992923536
Provider Name (Legal Business Name): PRUNI CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3026 N WOOSTER AVE
DOVER OH
44622
US

IV. Provider business mailing address

3026 N WOOSTER AVE
DOVER OH
44622
US

V. Phone/Fax

Practice location:
  • Phone: 330-364-4400
  • Fax: 330-364-1407
Mailing address:
  • Phone: 330-364-4400
  • Fax: 330-364-1407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1413
License Number StateOH

VIII. Authorized Official

Name: DR. STEPHEN M PRUNI III
Title or Position: OWNER
Credential: DO
Phone: 330-343-5262