Provider Demographics
NPI:1437343647
Name:FAMILY CHIROPRACTIC OF CIRCLEVILLE LLC
Entity type:Organization
Organization Name:FAMILY CHIROPRACTIC OF CIRCLEVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BELINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUMPENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-474-2921
Mailing Address - Street 1:1015 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-2143
Mailing Address - Country:US
Mailing Address - Phone:740-474-2921
Mailing Address - Fax:740-474-4941
Practice Address - Street 1:1015 S COURT ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-2143
Practice Address - Country:US
Practice Address - Phone:740-474-2921
Practice Address - Fax:740-474-4941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-30
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3313111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2550725Medicaid
OH2550716Medicaid
OH2550725Medicaid
OH2550716Medicaid