Provider Demographics
NPI:1730351412
Name:NORTH EAST OHIO SPINAL AID LLC
Entity type:Organization
Organization Name:NORTH EAST OHIO SPINAL AID LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-825-3221
Mailing Address - Street 1:1309 NORTON AVE SUITE 120
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203
Mailing Address - Country:US
Mailing Address - Phone:330-825-3221
Mailing Address - Fax:330-825-3224
Practice Address - Street 1:1309 NORTON AVE SUITE 120
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:OH
Practice Address - Zip Code:44203
Practice Address - Country:US
Practice Address - Phone:330-825-3221
Practice Address - Fax:330-825-3224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3659111N00000X
OH111N00000X
OH3446111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2592529Medicaid
OHMI4154004Medicare UPIN