MEDICARE: PROHEALTH CHIROPRACTIC AND MASSAGE, 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	3983	OH

General Provider Information

NPI Number	:	1942654629
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PROHEALTH CHIROPRACTIC AND MASSAGE, LLC

Provider Business Mailing Address
First Line	:	4880 S MAIN ST
Second Line	:	SUITE 5
City	:	AKRON
State	:	OH
Zip	:	44319-4474
Country	:	US
Telephone Number	:	330-563-4033
Fax Number	:	330-563-4169

Provider Business Practice Location Address
First Line	:	4880 S MAIN ST
Second Line	:	SUITE 5
City	:	AKRON
State	:	OH
Zip	:	44319-4474
Country	:	US
Telephone Number	:	330-563-4033
Fax Number	:	330-563-4169

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK JUSTIN TAYLOR
Credential	:	D.C.
Telephone Number	:	330-413-2628

Provider Enumeration Date	:	04/19/2016
Last Update Date	:	04/19/2016

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