MEDICARE: LORAIN COUNTY 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

General Provider Information

NPI Number	:	1780917153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LORAIN COUNTY CHIROPRACTIC, LLC

Provider Business Mailing Address
First Line	:	1919 VETERSND BOULEVARD
Second Line	:	SUITE 200
City	:	KENNER
State	:	LA
Zip	:	70062
Country	:	US
Telephone Number	:	504-467-0302
Fax Number	:

Provider Business Practice Location Address
First Line	:	1100 N ABBE RD STE C
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-1667
Country	:	US
Telephone Number	:	504-467-0302
Fax Number	:

Authorized Official
Title or Position	:	OPERATIONS MANAGER
Name	:	BUFFIE ROME
Credential	:
Telephone Number	:	504-467-0302

Provider Enumeration Date	:	09/16/2009
Last Update Date	:	09/16/2009

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