Provider Demographics
NPI:1902970528
Name:URGENT CARE AND MEDICAL CHIROPRACTIC REHAB, INC
Entity Type:Organization
Organization Name:URGENT CARE AND MEDICAL CHIROPRACTIC REHAB, INC
Other - Org Name:SALEM CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DALEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-745-2033
Mailing Address - Street 1:637 W TUSCARAWAS AVE
Mailing Address - Street 2:
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-2430
Mailing Address - Country:US
Mailing Address - Phone:330-745-2033
Mailing Address - Fax:330-745-0282
Practice Address - Street 1:568 EAST STATE STREET
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OH
Practice Address - Zip Code:44460-2933
Practice Address - Country:US
Practice Address - Phone:330-337-1441
Practice Address - Fax:330-337-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH626111N00000X
111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2310172Medicaid
OH2310172Medicaid
9314941Medicare PIN