MEDICARE: PLEASANT VALLEY CHIROPRACTIC CLINIC, 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	1815	OH

General Provider Information

NPI Number	:	1952514754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLEASANT VALLEY CHIROPRACTIC CLINIC, INC.

Provider Business Mailing Address
First Line	:	7664 BROADVIEW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44134-6746
Country	:	US
Telephone Number	:	216-520-6880
Fax Number	:	216-520-6885

Provider Business Practice Location Address
First Line	:	7664 BROADVIEW RD
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44134-6746
Country	:	US
Telephone Number	:	216-520-6880
Fax Number	:	216-520-6885

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	MR. OTTO J. SCHMIDT
Credential	:	D.C.
Telephone Number	:	216-520-6880

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	10/04/2011

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