Healthcare Provider Details

I. General information

NPI: 1487775706
Provider Name (Legal Business Name): EAST MENTOR FAMILY CHIROPRACTIC & REHABILITATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6966 HEISLEY RD SUITE F
MENTOR OH
44060-4593
US

IV. Provider business mailing address

6966 HEISLEY RD SUITE F
MENTOR OH
44060-4593
US

V. Phone/Fax

Practice location:
  • Phone: 440-974-8557
  • Fax: 440-255-6337
Mailing address:
  • Phone: 440-974-8557
  • Fax: 440-255-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2782
License Number StateOH

VIII. Authorized Official

Name: DR. MATTHEW RUSSELL WARD
Title or Position: PRESIDENT
Credential: D.C.
Phone: 440-974-8557