Provider Demographics
NPI:1871762393
Name:CONSILIENCE INC
Entity type:Organization
Organization Name:CONSILIENCE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:PALMER
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-456-4555
Mailing Address - Street 1:890 S BARRON ST
Mailing Address - Street 2:PO BOX 333
Mailing Address - City:EATON
Mailing Address - State:OH
Mailing Address - Zip Code:45320-9362
Mailing Address - Country:US
Mailing Address - Phone:937-456-4555
Mailing Address - Fax:
Practice Address - Street 1:890 S BARRON ST
Practice Address - Street 2:
Practice Address - City:EATON
Practice Address - State:OH
Practice Address - Zip Code:45320-9362
Practice Address - Country:US
Practice Address - Phone:937-456-4555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2603111N00000X
OH2701111N00000X
OHOT05454225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2174936Medicaid
OHU74385Medicare UPIN
OH2174936Medicaid
OH0866912Medicare PIN
OH216171Medicare UPIN
OH4135421Medicare PIN
OH9316771Medicare PIN