# F O R M E MEDICAL AND REHAB CENTER OF WARREN INC

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

## Provider details

- **NPI number:** 1245390343
- **Authorized official:** NESTOR A STYCHNO D.M., D.C. (PRESIDENT)
- **Authorized official phone:** (330) 544-3737

## Contact information

- **Practice address:** 2103 NILES CORTLAND RD SE, WARREN, OH 44484-3067
- **Practice address phone:** (330) 544-3737
- **Practice address fax:** (330) 544-3904
- **Mailing address:** 2103 NILES CORTLAND RD SE, WARREN, OH 44484-3067
- **Mailing address phone:** (330) 544-3737
- **Mailing address fax:** (330) 544-3904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 139 | OH | Yes |
| 111N00000X | Chiropractor | 2393 | OH | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 35050935 | OH | — |

## Other

- **Enumeration date:** 12/11/2006
- **Last updated:** 09/29/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0119473 | — | OH |
| 05 | — | 0608444 | — | OH |
| 05 | — | 2459129 | — | OH |