Southworth Active Spine And Rehab | |
8076 East Broad Street, Reynoldsburg, OH 43068-8024 | |
(614) 986-9103 | |
(614) 986-9619 |
Full Name | Southworth Active Spine And Rehab |
---|---|
Type | Facility |
Speciality | Chiropractor |
Location | 8076 East Broad Street, Reynoldsburg, Ohio |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1831550961 | NPI | - | NPPES |
1538421672 | Medicaid | OH |
Taxonomy | Type | License (State) | Status |
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111N00000X | Chiropractor | DC4208 (Ohio) | Primary |
Provider Name | Nicholas A Southworth |
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Provider Type | Practitioner - Chiropractic |
Provider Identifiers | NPI Number: 1538421672 PECOS PAC ID: 4688807266 Enrollment ID: I20140506001461 |
Mailing Address | Practice Location Address |
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Southworth Active Spine And Rehab 8076 E Broad St, Reynoldsburg, OH 43068-8024 Ph: (614) 986-9103 | Southworth Active Spine And Rehab 8076 East Broad Street, Reynoldsburg, OH 43068-8024 Ph: (614) 986-9103 |
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