Healthcare Provider Details

I. General information

NPI: 1376637082
Provider Name (Legal Business Name): JAMES J. BEDOCS D.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2106 N. RIDGE ROAD
ELYRIA OH
44035
US

IV. Provider business mailing address

2106 N. RIDGE ROAD
ELYRIA OH
44035
US

V. Phone/Fax

Practice location:
  • Phone: 440-324-2637
  • Fax: 440-277-6743
Mailing address:
  • Phone: 440-324-2637
  • Fax: 440-277-6743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172M00000X
TaxonomyMechanotherapist
License Number3238
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: