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General NPI Number Information
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NPI Number | 1881886604
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Entity Type | Organization
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Legal Business Name | PANCHUR CHIROPRACTIC CORP
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Dates
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Enumeration Date | 08/15/2007
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Last Update Date | 08/15/2007
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Provider Practice Location Address
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Address Line | 1197 HIGH ST SUITE 102
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-335-6070
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Fax | 330-335-6080
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Provider Business Mailing Address
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Address Line | 1197 HIGH ST SUITE 102
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City | WADSWORTH
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State | OH
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Zip | 44281-8282
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Country | US
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Telephone | 330-335-6070
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Fax | 330-335-6080
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER JANE PANCHUR
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Credential | D.C.
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Telephone | 330-335-6070
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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 | 2742
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License Number State | OH
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