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General NPI Number Information
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NPI Number | 1144484692
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Entity Type | Organization
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Legal Business Name | PRO FAMILY CHIROPRACTIC CENTER, LTD.
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 3680 STARRS CENTRE DR
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City | CANFIELD
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State | OH
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Zip | 44406-9514
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Country | US
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Telephone | 330-702-0500
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Fax | 330-702-0575
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Provider Business Mailing Address
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Address Line | 3680 STARRS CENTRE DR
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City | CANFIELD
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State | OH
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Zip | 44406-9514
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Country | US
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Telephone | 330-702-0500
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Fax | 330-702-0575
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. LISA M PROVENZA-TABAK
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Credential | D.C.
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Telephone | 330-702-0500
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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 | 2661
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License Number State | OH
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