Organization
MODERN CHIROPRACTIC & WELLNESS,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK D PETRO DC (OWNER)
(216) 712-6820
Entity
Organization
Contact information
Practice address
21800 LORAIN RD, FAIRVIEW PARK, OH 44126-3331
(216) 712-6820
Mailing address
1454 GENTRY MEMORIAL HWY, EASLEY, SC 29640-6940
(864) 644-2700
(864) 644-2710
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
SU139070
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4572
CHIROPRACTIC MEDICAL LICENSES
OH
Enumeration date
10/30/2017
Last updated
11/28/2017
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