Healthcare Provider Details

I. General information

NPI: 1801168596
Provider Name (Legal Business Name): RICH CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 01/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23285 STATE ROUTE 51 W
GENOA OH
43430-1042
US

IV. Provider business mailing address

23285 STATE ROUTE 51 W
GENOA OH
43430-1042
US

V. Phone/Fax

Practice location:
  • Phone: 419-855-7776
  • Fax:
Mailing address:
  • Phone: 419-855-7776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1375
License Number StateOH

VIII. Authorized Official

Name: DR. MARK EDWARD RICH
Title or Position: PRESIDENT
Credential: D.C.
Phone: 419-855-7776