=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356169882
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ACCIDENT CARE & WELLNESS CENTER II LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2024
-----------------------------------------------------
Last Update Date | 10/02/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4600 SMITH ROAD
-----------------------------------------------------
City | NORWOOD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45212
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 513-245-1724
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O. BOX 20770
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER PARTNER
-----------------------------------------------------
Name | MR. KABIN J. CARDER
-----------------------------------------------------
Credential | D.C
-----------------------------------------------------
Telephone | 614-235-3778
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------