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General NPI Number Information
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NPI Number | 1114133857
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Entity Type | Organization
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Legal Business Name | VAN AKEN HEALTH CENTER, INC.
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 20119 VAN AKEN BLVD SUITE 205
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-3636
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Country | US
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Telephone | 216-561-1994
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Fax | 216-561-0553
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Provider Business Mailing Address
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Address Line | 20119 VAN AKEN BLVD SUITE 205
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City | SHAKER HEIGHTS
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State | OH
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Zip | 44122-3636
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Country | US
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Telephone | 216-561-1994
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Fax | 216-561-0553
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Authorized Official
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Title or Position | OWNER
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Name | DR. RAYMOND MICHAEL BROCCOLI
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Credential | D.C.
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Telephone | 216-561-1994
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 2432
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License Number State | OH
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