Provider Demographics
NPI:1730378969
Name:BEDOCS, EUGENE M (DC)
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:M
Last Name:BEDOCS
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:GENE
Other - Middle Name:M
Other - Last Name:BEDOCS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DC
Mailing Address - Street 1:136 WINCKLES ST
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-6152
Mailing Address - Country:US
Mailing Address - Phone:440-365-8323
Mailing Address - Fax:440-365-8324
Practice Address - Street 1:136 WINCKLES ST
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-6152
Practice Address - Country:US
Practice Address - Phone:440-365-8323
Practice Address - Fax:440-365-8324
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-24
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH265111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH350031215OtherRAILROAD MEDICARE
OH000000127998OtherANTHEM
OH000000127998OtherANTHEM
OHBE0405112Medicare PIN