Organization
CHIROPRACTIC SPINE CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DANY/LAURA CAMBOURIS/DEW (MANAGER/BILLER)
(330) 220-2001
Entity
Organization
Contact information
Practice address
1930 PEARL RD, SUITE 2, BRUNSWICK, OH 44212-6477
(330) 220-2001
(330) 220-2232
Mailing address
1930 PEARL RD, SUITE 2, BRUNSWICK, OH 44212-6477
(330) 220-2001
(330) 220-2232
Taxonomy
Speciality
Code
Description
License number
State
111NR0400X
Rehabilitation Chiropractor
Primary
3400
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000374322
ANTHEM
OH
01
—
273826180-00
BWC
OH
01
—
273826180002
MEDICAL MUTUAL
OH
01
—
7141540
AETNA
OH
Enumeration date
04/25/2007
Last updated
10/24/2007
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