Basic Information
| Provider Information | |||||||||
| NPI: | 1558900779 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIROPRACTIC NEUROLOGY AND METABOLISM CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4334 W CENTRAL AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199027101 | ||||||||
| FaxNumber: | 8666598883 | ||||||||
| Practice Location | |||||||||
| Address1: | 4334 W CENTRAL AVE STE 210 | ||||||||
| Address2: | |||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436151679 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4199027101 | ||||||||
| FaxNumber: | 8666598883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/06/2020 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 4199027101 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NN0400X | Y | 193400000X SINGLE SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Neurology |
No ID Information.