Provider Demographics
NPI:1235718776
Name:SOUTHSIDE WELLNESS CENTER LTD
Entity type:Organization
Organization Name:SOUTHSIDE WELLNESS CENTER LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHOSHANA
Authorized Official - Middle Name:SEVEL
Authorized Official - Last Name:LOERCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-840-7419
Mailing Address - Street 1:7664 BROADVIEW RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-6746
Mailing Address - Country:US
Mailing Address - Phone:440-840-7419
Mailing Address - Fax:440-628-3503
Practice Address - Street 1:7664 BROADVIEW RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134-6746
Practice Address - Country:US
Practice Address - Phone:440-840-7419
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-02
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992049985OtherNPI INDIVIDUAL