=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205589330
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CINCINNATI ACCIDENT CENTER, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/29/2022
-----------------------------------------------------
Last Update Date | 01/29/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 SHARON PARK LN STE 150
-----------------------------------------------------
City | CINCINNATI
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45241-4171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-407-8953
-----------------------------------------------------
Fax | 513-429-0365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 128 SOUTHERN MANOR RD
-----------------------------------------------------
City | VANCEBURG
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 41179-7511
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-302-2744
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | TREASURER
-----------------------------------------------------
Name | DONNA CAUDILL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 740-302-2744
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------