=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699229336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ARC PHYSICAL MEDICINE & REHABILITATION LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/11/2016
-----------------------------------------------------
Last Update Date | 08/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4610 CARLYNN DR
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45241-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-361-8519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4610 CARLYNN DR
-----------------------------------------------------
City | BLUE ASH
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 45241-2202
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-361-8519
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOSEPH PIWOSZKIN
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 574-361-8519
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111NR0400X
-----------------------------------------------------
Taxonomy Name | Rehabilitation Chiropractor
-----------------------------------------------------
License Number | 4266
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------