Provider Demographics
NPI:1831362847
Name:RICHARD M PELKOWSKI D.C., D.M.
Entity type:Organization
Organization Name:RICHARD M PELKOWSKI D.C., D.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:PELKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC, DM
Authorized Official - Phone:330-499-7020
Mailing Address - Street 1:PO BOX 337
Mailing Address - Street 2:
Mailing Address - City:GREENTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44630-0337
Mailing Address - Country:US
Mailing Address - Phone:330-499-7020
Mailing Address - Fax:330-499-1120
Practice Address - Street 1:9700 CLEVELAND AVE NW
Practice Address - Street 2:
Practice Address - City:GREENTOWN
Practice Address - State:OH
Practice Address - Zip Code:44630-0337
Practice Address - Country:US
Practice Address - Phone:330-499-7020
Practice Address - Fax:330-499-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-10
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH144111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000127552OtherANTHEM
OH000000127552OtherANTHEM
OH0382231Medicare PIN