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General NPI Number Information
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NPI Number | 1720260979
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Entity Type | Organization
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Legal Business Name | COOPERATIVE MEDICAL HEALTH CARE CORPORATION PROFESSIONAL ASSOCIATION
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 05/21/2014
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Provider Practice Location Address
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Address Line | 165 W. BAGLEY RD.
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City | BEREA
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State | OH
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Zip | 44017
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Country | US
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Telephone | 440-826-1440
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Fax | 440-826-1126
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Provider Business Mailing Address
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Address Line | 165 W. BAGLEY RD.
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City | BEREA
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State | OH
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Zip | 44017
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Country | US
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Telephone | 440-826-1440
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Fax | 440-826-1126
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Authorized Official
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Title or Position | OFFICER
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Name | DR. ERIC MACANGA
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Credential | D.C.
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Telephone | 440-826-1440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172M00000X
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Taxonomy Name | Mechanotherapist
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License Number | 3639
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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 | 3521
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License Number State | OH
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