Provider Demographics
NPI:1730350364
Name:MUNROE FALLS CHIROPRACTIC PHYSICIANS LLC
Entity type:Organization
Organization Name:MUNROE FALLS CHIROPRACTIC PHYSICIANS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:330-686-1300
Mailing Address - Street 1:108 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MUNROE FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44262-1638
Mailing Address - Country:US
Mailing Address - Phone:330-686-1300
Mailing Address - Fax:330-686-9809
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:MUNROE FALLS
Practice Address - State:OH
Practice Address - Zip Code:44262-1638
Practice Address - Country:US
Practice Address - Phone:330-686-1300
Practice Address - Fax:330-686-9809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2526111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9328281Medicare PIN