MEDICARE: CHIRO CLEVELAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3883	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003126434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIRO CLEVELAND LLC

Provider Business Mailing Address
First Line	:	4269 PEARL RD STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4231
Country	:	US
Telephone Number	:	216-739-9000
Fax Number	:	216-739-9001

Provider Business Practice Location Address
First Line	:	4269 PEARL RD STE 200
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44109-4231
Country	:	US
Telephone Number	:	216-739-9000
Fax Number	:	216-739-9001

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ABRAHAM MEDLONG
Credential	:	D.C.
Telephone Number	:	216-739-9000

Provider Enumeration Date	:	10/19/2010
Last Update Date	:	10/19/2010

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Directions to “CHIRO CLEVELAND LLC ” Practice Location

Language	Start Address	Practice Location

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