Healthcare Provider Details

I. General information

NPI: 1730378969
Provider Name (Legal Business Name): EUGENE M BEDOCS DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: GENE M BEDOCS DC

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

136 WINCKLES ST
ELYRIA OH
44035-6152
US

IV. Provider business mailing address

136 WINCKLES ST
ELYRIA OH
44035-6152
US

V. Phone/Fax

Practice location:
  • Phone: 440-365-8323
  • Fax: 440-365-8324
Mailing address:
  • Phone: 440-365-8323
  • Fax: 440-365-8324

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number265
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: