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Organization
WESTERN RESERVE PROFESS
Active
Organization
WESTERN RESERVE PROFESS
Active
Other names
WESTERN RESERVE SPINE & PAIN INSTITUTE
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY ANN SEMANCIK (ADMINISTRATIVE DIRECTOR)
(330) 677-3628
Entity
Organization
Contact information
Practice address
307 W MAIN ST, KENT, OH 44240-2400
(330) 677-3628
(330) 677-3626
Mailing address
PO BOX 951971, CLEVELAND, OH 44193-0021
(330) 548-0080
(330) 548-0084
Taxonomy
Speciality
Code
Description
License number
State
111NX0800X
Orthopedic Chiropractor
—
NULL
111NX0800X
Orthopedic Chiropractor
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
NULL
208100000X
Physical Medicine & Rehabilitation Physician
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
NULL
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
Primary
—
—
Other
Enumeration date
05/01/2006
Last updated
10/24/2007
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