Provider Demographics
NPI:1902171184
Name:VILLAGE CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:VILLAGE CHIROPRACTIC, INC.
Other - Org Name:N/A
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-870-9559
Mailing Address - Street 1:5850 BOYMEL DR
Mailing Address - Street 2:UNIT 2
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-8529
Mailing Address - Country:US
Mailing Address - Phone:513-870-9559
Mailing Address - Fax:513-870-9593
Practice Address - Street 1:5850 BOYMEL DR
Practice Address - Street 2:UNIT 2
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-8529
Practice Address - Country:US
Practice Address - Phone:513-870-9559
Practice Address - Fax:513-870-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1348111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBE0610032Medicare PIN