Healthcare Provider Details

I. General information

NPI: 1447643697
Provider Name (Legal Business Name): PINNACLE CHIROPRACTIC AND PHYSICAL THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2015
Last Update Date: 05/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9315 COLUMBIA RD SW
ETNA OH
43062-7126
US

IV. Provider business mailing address

9315 COLUMBIA RD SW
ETNA OH
43062-7126
US

V. Phone/Fax

Practice location:
  • Phone: 740-963-3900
  • Fax: 740-963-3999
Mailing address:
  • Phone: 740-963-3900
  • Fax: 740-963-3999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3618
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number33.021808 E-G
License Number StateOH

VIII. Authorized Official

Name: AMANDA STEVENSON
Title or Position: DOCTOR
Credential: DC
Phone: 740-966-0068