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General NPI Number Information
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NPI Number | 1275602500
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Entity Type | Organization
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Legal Business Name | BACK & NECK CLINIC OF MADISON INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 6227 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2570
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Country | US
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Telephone | 440-428-2565
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Fax | 440-417-0192
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Provider Business Mailing Address
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Address Line | 6227 N RIDGE RD
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City | MADISON
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State | OH
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Zip | 44057-2570
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Country | US
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Telephone | 440-428-2565
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Fax | 440-417-0192
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Authorized Official
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Title or Position | OWNER CEO
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Name | DR. RANDY D TRICE
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Credential | DC
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Telephone | 440-428-2565
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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 | 1466
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License Number State | OH
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