Provider Demographics
NPI:1487993119
Name:MASON CHIROPRACTIC AND REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:MASON CHIROPRACTIC AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:SLATER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-398-2020
Mailing Address - Street 1:111 READING RD
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1633
Mailing Address - Country:US
Mailing Address - Phone:513-398-2020
Mailing Address - Fax:513-398-9067
Practice Address - Street 1:111 READING RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-1633
Practice Address - Country:US
Practice Address - Phone:513-398-2020
Practice Address - Fax:513-398-9067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-31
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU45965Medicare UPIN
OH0960321Medicaid
OHJO0834181Medicare PIN