=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891139275
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CHIROPRACTIC & REHABILITATION FOR INJURIES AND WELLNESS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2013
-----------------------------------------------------
Last Update Date | 04/29/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5195 MAYFIELD RD SUITE 10
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-720-1810
-----------------------------------------------------
Fax | 440-720-1814
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5195 MAYFIELD RD SUITE 10
-----------------------------------------------------
City | LYNDHURST
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44124-2464
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-720-1810
-----------------------------------------------------
Fax | 440-720-1814
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MRS. DENAE S JONES
-----------------------------------------------------
Credential | MBA
-----------------------------------------------------
Telephone | 216-571-0774
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 2942
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------