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General NPI Number Information
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NPI Number | 1508130469
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Entity Type | Organization
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Legal Business Name | NORTH COAST CHIROPRACTIC
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Dates
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Enumeration Date | 02/23/2012
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Last Update Date | 02/29/2012
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Provider Practice Location Address
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Address Line | 362 E BRIDGE ST
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City | ELYRIA
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State | OH
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Zip | 44035-5223
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Country | US
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Telephone | 440-323-3840
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Fax | 440-323-1566
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Provider Business Mailing Address
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Address Line | 362 E BRIDGE ST
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City | ELYRIA
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State | OH
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Zip | 44035-5223
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Country | US
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Telephone | 440-323-3840
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Fax | 440-323-1566
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Authorized Official
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Title or Position | OWNER
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Name | DR. ROBERT F DEMARIA
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Credential | DC DABCO FASBE
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Telephone | 440-323-3840
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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 | 4254
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 4255
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 730
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License Number State | OH
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