Organization
GREAT LAKES PHYSICAL MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC D WOLK DC (OWNER)
(570) 575-5414
Entity
Organization
Contact information
Practice address
25200 CHAGRIN BLVD STE 103, BEACHWOOD, OH 44122-5681
(570) 575-5414
Mailing address
25200 CHAGRIN BLVD STE 103, BEACHWOOD, OH 44122-5681
(570) 575-5414
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
261QP2000X
Physical Therapy Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0281891
—
OH
Enumeration date
02/08/2020
Last updated
02/08/2020
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