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General NPI Number Information
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NPI Number | 1396280111
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Entity Type | Organization
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Legal Business Name | BLUE RIBBON CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 101 E PARK AVE
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City | COLUMBIANA
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State | OH
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Zip | 44408-1352
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Country | US
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Telephone | 330-482-2556
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Fax | 330-482-3114
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Provider Business Mailing Address
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Address Line | 101 E PARK AVE
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City | COLUMBIANA
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State | OH
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Zip | 44408-1352
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Country | US
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Telephone | 330-482-2556
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Fax | 330-482-3114
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Authorized Official
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Title or Position | CHIROPRACTIC PHYSICIAN
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Name | DR. LISA N BRADEN
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Credential | D.C.
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Telephone | 330-482-2556
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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 | 4582
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License Number State | OH
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