COUNTRYSIDE CLINIC OF CHIROPRACTIC, LLC (NPI# 1063837367) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063837367 |
| Entity Type | Organization |
| Organization Name | COUNTRYSIDE CLINIC OF CHIROPRACTIC, LLC |
| Practice Address |
990 Belvedere Dr Ste B Lebanon OH 45036-1193 |
| Practice Telephone | 5138368844 |
| Practice Fax Number | 5138368845 |
| Mailing Telephone | 5138368844 |
| Mailing Fax Number | 5138368845 |
| Enumeration Date | 2014-02-23 |
| Last Update Date | 2019-11-26 |
| Authorized Official Name | DR. TONY DEJTIRANUKUL (OWNER) |
| Authorized Official Telephone | 3144966030 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | 4008 | OH | Chiropractic Providers |
| Street Address |
990 BELVEDERE DR STE B |
| City | LEBANON |
| State | OH |
| Zip Code | 45036-1193 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497086953 | Tony Dejtiranukul | Chiropractor | 990 Belvedere Dr Ste B, Lebanon, OH 45036-1193 | 2010-01-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205479458 | Natasha Denney Arentz | Nurse Practitioner | 5787 Oh-63, Lebanon, OH 45036 | 2019-10-21 |
| 1265086573 | Eric Stone | Counselor | 5234 Oh-63, Lebanon, OH 45036 | 2019-07-25 |
| 1548730401 | Crystal Prater | Counselor | 5234 W Sr 63, Lebanon, OH 45036 | 2018-12-04 |
| 1922574284 | Ellen L Fink | Counselor | 5234 Sr 63, Lebanon, OH 45036 | 2018-10-15 |
| 1255832275 | Primary Care Partners of Ohio | Family Medicine | 726 E Main St Ste F205, Lebanon, OH 45036 | 2018-02-25 |
| 1548769599 | Chelsea R Perkins | Case Manager/Care Coordinator | 975 Kingsview Drive Bldg B, Lebanon, OH 45036 | 2018-02-06 |
| 1184133829 | Mary Bennett | Speech-Language Pathologist | 6760 Oh St Rt. 34, Lynchburg, OH 45036 | 2017-09-26 |
| 1699292912 | Robert Earl Offutt | Counselor | 5234 State Rt.63, Lebanon, OH 45036 | 2017-08-28 |
| 1407381528 | Kari Bump | Counselor | 320 E Silver St, Lebanon, OH 45036 | 2017-04-26 |
| 1154780435 | Ohio Department of Rehabilitation and Correction | Public Health or Welfare | State Route 63, Lebanon, OH 45036 | 2016-02-16 |
| Find all providers in zip 45036 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396351698 | Comforting Hands Chiropractic LLC | Chiropractor | 1151 Cornwall Rd Ste 5, Lebanon, PA 17042-7233 | 2020-09-22 |
| 1821637026 | Molly Anna Pepin | Chiropractor | 103 Hanover St Ste 14, Lebanon, NH 03766-1098 | 2020-01-06 |
| 1508222068 | Margaret Swick | Chiropractor | 291 N Adams Ave, Lebanon, MO 65536-3045 | 2016-01-13 |
| 1750759684 | Crv Sport and Spine | Chiropractor | 103 Hanover St Ste 17, Lebanon, NH 03766-1098 | 2015-09-09 |
| 1700208212 | Lebanon Chiropractic Center | Chiropractor | 2234 Cumberland St, Lebanon, PA 17042-2583 | 2014-01-17 |
| 1356613384 | Center for Natural Health and Rehabilitation Inc | Chiropractor | 1386 Us Highway 22, Lebanon, NJ 08833-2205 | 2012-02-07 |
| 1497086953 | Tony Dejtiranukul | Chiropractor | 990 Belvedere Dr Ste B, Lebanon, OH 45036-1193 | 2010-01-23 |
| 1184855637 | Ronald Gary Clibborn | Chiropractor | 75 E Oak St, Lebanon, OR 97355-3223 | 2009-07-31 |
| 1912148982 | Susan K Kellogg | Chiropractor | 37 Bank St, Lebanon, NH 03766-1703 | 2009-03-20 |
| 1497902613 | Douglas Willen | Chiropractor | 1 Split Rail Ct, Lebanon, NJ 08833-3248 | 2008-08-19 |
| Find all providers in LEBANON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.