Healthcare Provider Details

I. General information

NPI: 1386002889
Provider Name (Legal Business Name): RICHFIELD CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 BROADVIEW RD
RICHFIELD OH
44286-9230
US

IV. Provider business mailing address

4028 BROADVIEW RD
RICHFIELD OH
44286-9230
US

V. Phone/Fax

Practice location:
  • Phone: 330-659-4955
  • Fax: 330-659-6052
Mailing address:
  • Phone: 330-659-4955
  • Fax: 330-659-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number991
License Number StateOH

VIII. Authorized Official

Name: DR. GARY CRAMER DOMANICK
Title or Position: MANAGING MEMBER
Credential: D.C
Phone: 330-659-4955