GREAT LAKES PHYSICAL MEDICINE LLC (NPI# 1356973267) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356973267 |
| Entity Type | Organization |
| Organization Name | GREAT LAKES PHYSICAL MEDICINE LLC |
| Practice Address |
25200 Chagrin Blvd Ste 103 Beachwood OH 44122-5681 |
| Practice Telephone | 5705755414 |
| Mailing Telephone | 5705755414 |
| Enumeration Date | 2020-02-08 |
| Last Update Date | 2020-02-08 |
| Authorized Official Name | ERIC D WOLK (OWNER) |
| Authorized Official Telephone | 5705755414 |
| Authorized Official Credential | DC |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 261QP2000X |
Clinic/Center Specialization: Physical Therapy |
Ambulatory Health Care Facilities | ||
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OH | 0281891 | 05 |
| Street Address |
25200 CHAGRIN BLVD STE 103 |
| City | BEACHWOOD |
| State | OH |
| Zip Code | 44122-5681 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346754595 | Anne Margaret Kinchen | Acupuncturist | 25200 Chagrin Blvd Ste 103, Beachwood, OH 44122-5681 | 2017-11-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760083174 | Sophia Denise Moncrieffe-jordan | Nurse Practitioner | 23511 Chargin Blvd, Apt. E312, Beachwood, OH 44122 | 2020-11-03 |
| 1447864400 | Resilient Bodies LLC | Massage Therapist | 24300 Chagrin Blvd #312, Beachwood, OH 44122 | 2020-09-06 |
| 1215576087 | Hni Emergency Services of Ohio, LLC | Nurse Practitioner | 22501 Chagrin Blvd, Beachwood, OH 44122 | 2019-12-27 |
| 1013555648 | Barbara L Ekelman Phd Inc | Psychologist | 24100 Chagrin Blvd, Suite 385, Beachwood, OH 44122 | 2019-12-13 |
| 1417599770 | Janise Moore | Technician | 19600 Gladstone Rd, Warrensville Hts, OH 44122 | 2019-10-08 |
| 1598312704 | Nizar Andria | Student in an Organized Health Care Education/Training Program | Cedar Rd 27050, Apartment 515, Beachwood, OH 44122 | 2019-08-22 |
| 1437703998 | Malinda Ann Davis | Social Worker | 20600 Chagrin Blvd Suite 320, Shaker Heights, OH 44122 | 2019-08-01 |
| 1891265864 | Karlan Champagne | Case Management | 23215 Commerence Park, 306, Beachwood, OH 44122 | 2018-12-03 |
| 1952896565 | Donna Pinkney | Counselor | 20550 University Blvd Apt 206, Shaker Hts, OH 44122 | 2018-06-26 |
| 1255825857 | Elizabeth Anne Donathan | Registered Nurse | 4100 Warrensville Center Rd Ste 101, Warrensville Heights, OH 44122 | 2018-06-18 |
| Find all providers in zip 44122 | ||||
| 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 |
|---|---|---|---|---|
| 1023519394 | Rbpc Cleveland LLC | Chiropractor | 21625 Chagrin Blvd Ste 240, Beachwood, OH 44122-5335 | 2018-02-22 |
| 1548705312 | Patrick Joseph Pfantz | Chiropractor | 3401 Enterprise Pkwy Ste 110, Beachwood, OH 44122-7340 | 2017-01-03 |
| 1598026452 | Essington Family Chiropractic LLC | Chiropractor | 212 Atlantic City Blvd, Beachwood, NJ 08722-2905 | 2012-06-06 |
| 1245494251 | Essington Family Chiropractic | Chiropractor | 205 Atlantic City Blvd, Beachwood, NJ 08722-2904 | 2008-07-18 |
| 1215001110 | Carolyn Essington | Chiropractor | 701 Atlantic City Blvd, Beachwood, NJ 08722-4009 | 2006-11-20 |
| 1538240056 | Boris Kamkha | Chiropractor | 23408 Greenlawn Ave, Beachwood, OH 44122-1426 | 2006-10-18 |
| 1992707988 | Carmen J. Centanni | Chiropractor | 3681 South Green Rd., Suite #206, Beachwood, OH 44122 | 2005-08-10 |
| 1306476387 | Nicholas Jerome Essington | Chiropractor | 701 Atlantic City Blvd, Beachwood, NJ 08722-4009 | 2020-01-18 |
| 1326523226 | Pollack Health and Wellness 2 Pa | Chiropractor | 137 Atlantic City Blvd, Beachwood, NJ 08722-2935 | 2018-09-27 |
| 1861917775 | Brandon Pollack | Chiropractor | 137 Atlantic City Blvd, Beachwood, NJ 08722-2935 | 2017-08-11 |
| Find all providers in BEACHWOOD | ||||
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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.