Provider Demographics
NPI:1184776957
Name:ONE HEALTHCARE CENTER, INC.
Entity type:Organization
Organization Name:ONE HEALTHCARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORST
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:937-767-2733
Mailing Address - Street 1:PO BOX 470
Mailing Address - Street 2:100 CORRY ST.
Mailing Address - City:YELLOW SPRINGS
Mailing Address - State:OH
Mailing Address - Zip Code:45387-0470
Mailing Address - Country:US
Mailing Address - Phone:937-767-2733
Mailing Address - Fax:937-767-2736
Practice Address - Street 1:100 CORRY ST
Practice Address - Street 2:
Practice Address - City:YELLOW SPRINGS
Practice Address - State:OH
Practice Address - Zip Code:45387-1809
Practice Address - Country:US
Practice Address - Phone:937-767-2733
Practice Address - Fax:937-767-2736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2168111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2055716Medicaid
OH280509362-00OtherWORKERS COMP
OH000000211047OtherANTHEM BLUE CROSS&BLUE SH
OHBO0842481OtherMEDICARE INDIVIDUAL PIN
OH280509362-00OtherWORKERS COMP