Provider Demographics
NPI:1871715037
Name:ADVANCED CHIROPRACTIC OF COSHOCTON COUNTY
Entity type:Organization
Organization Name:ADVANCED CHIROPRACTIC OF COSHOCTON COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CAUDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-291-8100
Mailing Address - Street 1:112 CHESTNUT ST
Mailing Address - Street 2:PO BOX 1057
Mailing Address - City:COSHOCTON
Mailing Address - State:OH
Mailing Address - Zip Code:43812-1129
Mailing Address - Country:US
Mailing Address - Phone:740-291-8100
Mailing Address - Fax:740-291-8400
Practice Address - Street 1:112 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:COSHOCTON
Practice Address - State:OH
Practice Address - Zip Code:43812
Practice Address - Country:US
Practice Address - Phone:740-291-8100
Practice Address - Fax:740-291-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAD9328851Medicare PIN