Healthcare Provider Details

I. General information

NPI: 1447330766
Provider Name (Legal Business Name): ACTION SPINE AND PAIN CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 BAKER BLVD
FAIRLAWN OH
44333-3601
US

IV. Provider business mailing address

57 BAKER BLVD
FAIRLAWN OH
44333-3601
US

V. Phone/Fax

Practice location:
  • Phone: 330-666-1400
  • Fax:
Mailing address:
  • Phone: 330-666-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number35084026
License Number StateOH

VIII. Authorized Official

Name: DHRUV J SHAH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 330-572-0641