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General NPI Number Information
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NPI Number | 1972972495
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Entity Type | Organization
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Legal Business Name | INNOVATIVE FAMILY WELLNESS LLC
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Dates
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Enumeration Date | 09/15/2015
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 7000 SOUTH AVE SUITE 2
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City | BOARDMAN
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State | OH
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Zip | 44512-3644
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Country | US
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Telephone | 330-726-3456
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Fax | 330-726-2858
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Provider Business Mailing Address
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Address Line | 7000 SOUTH AVE SUITE 2
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City | BOARDMAN
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State | OH
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Zip | 44512-3644
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Country | US
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Telephone | 330-726-3456
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Fax | 330-726-2858
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Authorized Official
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Title or Position | PRESIDENT
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Name | NOAH C ERICKSON
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Credential | DC
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Telephone | 330-726-3456
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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 | DC.4332
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License Number State | OH
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