Healthcare Provider Details

I. General information

NPI: 1356351464
Provider Name (Legal Business Name): OXFORD MEDICAL HEALTH & WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5144 COLLEGE CORNER PIKE SUITE A
OXFORD OH
45056-2129
US

IV. Provider business mailing address

5144 COLLEGE CORNER PIKE SUITE A
OXFORD OH
45056-2129
US

V. Phone/Fax

Practice location:
  • Phone: 513-524-4800
  • Fax: 513-523-8631
Mailing address:
  • Phone: 513-524-4800
  • Fax: 513-523-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251S0007X
TaxonomySports Physical Therapist
License Number07243
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2292
License Number StateOH

VIII. Authorized Official

Name: DR. STACY A CHIDESTER
Title or Position: OWNER/OPERATOR
Credential: D.C.
Phone: 513-524-4800