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General NPI Number Information
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NPI Number | 1750926317
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Entity Type | Organization
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Legal Business Name | NEURORADIANCE INTEGRATIVE HEALTH INITIATIVE, LTD
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/07/2019
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Provider Practice Location Address
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Address Line | 110 POLARIS PKWY STE 120
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City | WESTERVILLE
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State | OH
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Zip | 43082-8028
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Country | US
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Telephone | 614-776-0624
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Fax | 614-591-9486
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Provider Business Mailing Address
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Address Line | 110 POLARIS PKWY STE 120
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City | WESTERVILLE
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State | OH
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Zip | 43082-8028
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Country | US
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Telephone | 614-776-0624
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RICHARD COOPER
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Credential | MD
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Telephone | 614-776-0624
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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