Modern Chiropractic & Wellness,LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

SU139070 Issued in OH

Legal business name

MODERN CHIROPRACTIC & WELLNESS,LLC

Practice address

21800 Lorain Rd
Fairview Park, OH 44126-3331

Phone

(216) 712-6820

NPI assigned

Oct 30, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Mark D Petro, DCNPI 1609235464

Title

Owner

Phone

(216) 712-6820

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mark Petro, D.C.

  • Chiropractor
  • Fairview Park, OH
  • NPI 1609235464
  Medicare reassignment NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511827200000",
    "number": "1073025185",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1454 GENTRY MEMORIAL HWY",
            "city": "EASLEY",
            "state": "SC",
            "postal_code": "296406940",
            "telephone_number": "864-644-2700",
            "fax_number": "864-644-2710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21800 LORAIN RD",
            "city": "FAIRVIEW PARK",
            "state": "OH",
            "postal_code": "441263331",
            "telephone_number": "216-712-6820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN CHIROPRACTIC & WELLNESS,LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-30",
        "last_updated": "2017-11-28",
        "status": "A",
        "authorized_official_last_name": "PETRO",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-712-6820",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "SU139070",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CHIROPRACTIC MEDICAL LICENSES",
            "identifier": "4572",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marcello M. Mellino, MD
• Matthew Joseph Messina, D.D.S.
• Jason Dean Milbert, PA-C
• Roy Miler, MD
• Paul Edward Miles
• David Molseed
• Frederick L Morey, DO
• Cassandra Morton, M.ED.
• Rafif Mousa, MD
• Basel Moussa, MD

• Chiropractor in Fairview Park, OH
• Providers in Fairview Park, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.