Healthcare Provider Details

I. General information

NPI: 1982804175
Provider Name (Legal Business Name): LOGAN FAMILY CHIROPRACTIC & REHABILITATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2007
Last Update Date: 10/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 STATE ROUTE 664 N UNIT D
LOGAN OH
43138-9250
US

IV. Provider business mailing address

PO BOX 29
LOGAN OH
43138-1831
US

V. Phone/Fax

Practice location:
  • Phone: 740-385-4141
  • Fax: 740-385-3838
Mailing address:
  • Phone: 740-385-4141
  • Fax: 740-385-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3158
License Number StateOH

VIII. Authorized Official

Name: DR. CHRISTIAN ERNEST GEDEON
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C.
Phone: 740-385-4141