Healthcare Provider Details

I. General information

NPI: 1669671509
Provider Name (Legal Business Name): BUCKEYE CHIROPRACTIC AND REHAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 VICTOR RD NW
LANCASTER OH
43130-7883
US

IV. Provider business mailing address

1619 VICTOR RD NW
LANCASTER OH
43130-7883
US

V. Phone/Fax

Practice location:
  • Phone: 740-653-5390
  • Fax: 740-653-2808
Mailing address:
  • Phone: 740-653-5390
  • Fax: 740-653-2808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1714
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number001396
License Number StateOH

VIII. Authorized Official

Name: DR. TODD B WALTERS
Title or Position: OWNER
Credential: DC
Phone: 740-653-5390