Provider Demographics
NPI:1144326356
Name:FEDORKO CHIROPRACTIC HEALTH CTR
Entity type:Organization
Organization Name:FEDORKO CHIROPRACTIC HEALTH CTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:FEDORKO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-494-0422
Mailing Address - Street 1:4774 MUNSON ST NW
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-3634
Mailing Address - Country:US
Mailing Address - Phone:330-494-0422
Mailing Address - Fax:330-494-3601
Practice Address - Street 1:4774 MUNSON ST NW
Practice Address - Street 2:SUITE 302
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3634
Practice Address - Country:US
Practice Address - Phone:330-494-0422
Practice Address - Fax:330-494-3601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH919111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3413757900OtherWORKERS COMPENSATION
OH0645314Medicaid
T47470Medicare UPIN
OH0645314Medicaid