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General NPI Number Information
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NPI Number | 1194823658
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Entity Type | Organization
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Legal Business Name | ELYRIA CHIROPRACTIC SERVICES INC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 136 WINCKLES STREET
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City | ELYRIA
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State | OH
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Zip | 44035-6152
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Country | US
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Telephone | 440-365-8323
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Fax | 440-365-8324
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Provider Business Mailing Address
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Address Line | 136 WINCKLES STREET
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City | ELYRIA
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State | OH
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Zip | 44035-6152
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Country | US
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Telephone | 440-365-8323
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Fax | 440-365-8324
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GENE M BEDOCS
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Credential | DC
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Telephone | 440-365-8323
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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 | 265
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License Number State | OH
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