=====================================================
General NPI Number Information
=====================================================
NPI Number | 1265561088
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SEVERANCE CHIROPRACTIC AND REHABILITATION INC FUNCTIONAL ORTHOPEDICS A
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/05/2007
-----------------------------------------------------
Last Update Date | 08/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5109 MAYFIELD RD
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-565-7855
-----------------------------------------------------
Fax | 440-565-7892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5109 MAYFIELD RD
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2405
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-565-7855
-----------------------------------------------------
Fax | 440-565-7892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CEO
-----------------------------------------------------
Name | DR. JAMES JOHN CARTINIAN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 440-565-7855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------