MEDICARE: NECK BACK AND BODY ACCIDENT AND INJURY THERAPY CLINIC

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	2545	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	:	1306005756
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NECK BACK AND BODY ACCIDENT AND INJURY THERAPY CLINIC

Provider Business Mailing Address
First Line	:	13357 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3408
Country	:	US
Telephone Number	:	216-941-1919
Fax Number	:	216-941-2929

Provider Business Practice Location Address
First Line	:	13357 LORAIN AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44111-3408
Country	:	US
Telephone Number	:	216-941-1919
Fax Number	:	216-941-2929

Authorized Official
Title or Position	:	COOWNER
Name	:	DR. THOMAS KAVOUNAS
Credential	:	D.C.
Telephone Number	:	216-941-1919

Provider Enumeration Date	:	06/02/2008
Last Update Date	:	07/08/2008

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