Healthcare Provider Details

I. General information

NPI: 1831303288
Provider Name (Legal Business Name): IRONTON PARK AVENUE CHIROPRACTIC CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 10/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 PARK AVE
IRONTON OH
45638-1529
US

IV. Provider business mailing address

901 PARK AVE
IRONTON OH
45638-1529
US

V. Phone/Fax

Practice location:
  • Phone: 740-532-8888
  • Fax: 740-532-1796
Mailing address:
  • Phone: 740-532-8888
  • Fax: 740-532-1796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. JULIE A. LEIST
Title or Position: MANAGER
Credential:
Phone: 740-622-7108