Healthcare Provider Details

I. General information

NPI: 1700326923
Provider Name (Legal Business Name): WESTLAKE INJURY CENTER MEDICAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29099 HEALTH CAMPUS DR STE 230
WESTLAKE OH
44145-5269
US

IV. Provider business mailing address

29099 HEALTH CAMPUS DR STE 230
WESTLAKE OH
44145-5269
US

V. Phone/Fax

Practice location:
  • Phone: 440-835-6263
  • Fax: 440-892-6632
Mailing address:
  • Phone: 440-835-6263
  • Fax: 440-892-6632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name: TY DAHODWALA
Title or Position: OWNER
Credential: DC
Phone: 440-835-6263