# CHARDON FAMILY CHIROPRACTIC CLINIC INC.

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

## Provider details

- **NPI number:** 1689858169
- **Authorized official:** DR. BARRY J KOTHEIMER D.C. (PRESIDENT)
- **Authorized official phone:** (440) 286-2225

## Contact information

- **Practice address:** 102 EAST PARK STREET, CHARDON, OH 44024-1237
- **Practice address phone:** (440) 286-2225
- **Practice address fax:** (440) 286-3058
- **Mailing address:** 102 EAST PARK STREET, CHARDON, OH 44024-1237
- **Mailing address phone:** (440) 286-2225
- **Mailing address fax:** (440) 286-3058

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 111N00000X | Chiropractor | 1511 | OH | Yes |

## Other

- **Enumeration date:** 12/20/2007
- **Last updated:** 01/16/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0759479 | — | OH |