# MODERN CHIROPRACTIC & WELLNESS,LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073025185
- **Authorized official:** DR. MARK D PETRO DC (OWNER)
- **Authorized official phone:** (216) 712-6820

## Contact information

- **Practice address:** 21800 LORAIN RD, FAIRVIEW PARK, OH 44126-3331
- **Practice address phone:** (216) 712-6820
- **Mailing address:** 1454 GENTRY MEMORIAL HWY, EASLEY, SC 29640-6940
- **Mailing address phone:** (864) 644-2700
- **Mailing address fax:** (864) 644-2710

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | SU139070 | OH | Yes |

## Other

- **Enumeration date:** 10/30/2017
- **Last updated:** 11/28/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 4572 | CHIROPRACTIC MEDICAL LICENSES | OH |