MEDICARE: GOOD HEALTH CHIROPRACTIC & THERAPY CENTER, 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

General Provider Information

NPI Number	:	1144207374
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HEALTH CHIROPRACTIC & THERAPY CENTER, LLC

Provider Business Mailing Address
First Line	:	15728 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5542
Country	:	US
Telephone Number	:	440-777-6017
Fax Number	:	440-777-6940

Provider Business Practice Location Address
First Line	:	15728 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-5542
Country	:	US
Telephone Number	:	216-252-6224
Fax Number	:	216-252-6234

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL C. WILSON
Credential	:	D.C.
Telephone Number	:	216-252-6224

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	09/25/2008

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