MEDICARE: SOUTHEAST CHIROPRACTIC AND THERAPY CENTER INC

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	:	1295854669
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST CHIROPRACTIC AND THERAPY CENTER INC

Provider Business Mailing Address
First Line	:	23131 EMERY RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5136
Country	:	US
Telephone Number	:	216-514-9590
Fax Number	:	216-514-9592

Provider Business Practice Location Address
First Line	:	23131 EMERY RD
Second Line	:
City	:	WARRENSVILLE HEIGHTS
State	:	OH
Zip	:	44128-5136
Country	:	US
Telephone Number	:	216-514-9590
Fax Number	:	216-514-9592

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL DIXON
Credential	:
Telephone Number	:	216-514-9590

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	08/22/2020

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