Healthcare Provider Details

I. General information

NPI: 1821289646
Provider Name (Legal Business Name): LONDON CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

61 E HIGH ST
LONDON OH
43140-1247
US

IV. Provider business mailing address

61 E HIGH ST
LONDON OH
43140-1247
US

V. Phone/Fax

Practice location:
  • Phone: 740-852-0717
  • Fax: 740-852-0828
Mailing address:
  • Phone: 740-852-0717
  • Fax: 740-852-0828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1117
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number1117
License Number StateOH

VIII. Authorized Official

Name: DR. GARY ROY GOLDSTEIN
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 740-852-0717