# WESTERN RESERVE PROFESS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** WESTERN RESERVE SPINE & PAIN INSTITUTE
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356308407
- **Authorized official:** KELLY ANN SEMANCIK (ADMINISTRATIVE DIRECTOR)
- **Authorized official phone:** (330) 677-3628

## Contact information

- **Practice address:** 307 W MAIN ST, KENT, OH 44240-2400
- **Practice address phone:** (330) 677-3628
- **Practice address fax:** (330) 677-3626
- **Mailing address:** PO BOX 951971, CLEVELAND, OH 44193-0021
- **Mailing address phone:** (330) 548-0080
- **Mailing address fax:** (330) 548-0084

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |

## Other

- **Enumeration date:** 05/01/2006
- **Last updated:** 10/24/2007