Healthcare Provider Details

I. General information

NPI: 1568699775
Provider Name (Legal Business Name): PARMATOWN SPINAL REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2009
Last Update Date: 08/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 RIDGE ROAD SUITE 202
PARMA OH
44129-0000
US

IV. Provider business mailing address

6900 RIDGE ROAD SUITE 202
PARMA OH
44129-0000
US

V. Phone/Fax

Practice location:
  • Phone: 440-888-4526
  • Fax: 440-888-9102
Mailing address:
  • Phone: 440-888-4526
  • Fax: 440-888-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3343
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number3343
License Number StateOH

VIII. Authorized Official

Name: DR. JOHN ROMAN FORTUNA
Title or Position: CHIROPRACTOR/OWNER
Credential: D.C.
Phone: 440-888-4526