Healthcare Provider Details

I. General information

NPI: 1578717427
Provider Name (Legal Business Name): CENTER FOR SPINECARE AND NATURAL MEDICINE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2008
Last Update Date: 11/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34820 CHARDON RD
WILLOUGHBY OH
44094-9103
US

IV. Provider business mailing address

34820 CHARDON RD
WILLOUGHBY OH
44094-9103
US

V. Phone/Fax

Practice location:
  • Phone: 440-944-4300
  • Fax: 440-944-4302
Mailing address:
  • Phone: 440-944-4300
  • Fax: 440-944-4302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN L. PALGUT
Title or Position: PRESIDENT
Credential: D.C.
Phone: 440-944-4300