MEDICARE: COURTHOUSE FAMILY CHIROPRACTIC, 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	OH2706	OH
2	111NX0100X	Occupational Health Chiropractor	3998	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	:	1568692036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COURTHOUSE FAMILY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1135 LEESBURG AVE
Second Line	:
City	:	WASHINGTON COURT HOUSE
State	:	OH
Zip	:	43160-1269
Country	:	US
Telephone Number	:	740-333-9000
Fax Number	:	740-333-1847

Provider Business Practice Location Address
First Line	:	1135 LEESBURG AVE
Second Line	:
City	:	WASHINGTON COURT HOUSE
State	:	OH
Zip	:	43160-1269
Country	:	US
Telephone Number	:	740-333-9000
Fax Number	:	740-333-1847

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	ROMAN ADAM MATTHEWS
Credential	:	D.C.
Telephone Number	:	740-333-9000

Provider Enumeration Date	:	07/20/2009
Last Update Date	:	07/31/2024

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