Basic Information
| Provider Information | |||||||||
| NPI: | 1740823269 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | APPLIED KINESIOLOGY CHIROPRACTIC OF CLEVELAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 35104 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408675102 | ||||||||
| FaxNumber: | 8666598883 | ||||||||
| Practice Location | |||||||||
| Address1: | 35104 EUCLID AVE | ||||||||
| Address2: | |||||||||
| City: | WILLOUGHBY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 440944516 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4408675102 | ||||||||
| FaxNumber: | 8666598883 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2019 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| AuthorizedOfficialLastName: | DEVENS | ||||||||
| AuthorizedOfficialFirstName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PROVIDER/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4408675102 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NN1001X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Nutrition |
No ID Information.