Pro Family Chiropractic Center, LTD.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

2661 Issued in OH

Legal business name

PRO FAMILY CHIROPRACTIC CENTER, LTD.

Practice address

3680 Starrs Centre Dr
Canfield, OH 44406-9514

Phone

(330) 702-0500

Fax

(330) 702-0575

NPI assigned

Jul 14, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Lisa M Provenza-Tabak, D.C.NPI 1871583948

Title

Doctor of Chiropractic

Phone

(330) 702-0500

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in OH

Enrollment records 1

Locations

Practitioners 1

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

• Lisa M Provenza-Tabak, D.C.

  • Chiropractor
  • Canfield, OH
  • NPI 1871583948
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1215993600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215993600000",
    "number": "1144484692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3680 STARRS CENTRE DR",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069514",
            "telephone_number": "330-702-0500",
            "fax_number": "330-702-0575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3680 STARRS CENTRE DR",
            "city": "CANFIELD",
            "state": "OH",
            "postal_code": "444069514",
            "telephone_number": "330-702-0500",
            "fax_number": "330-702-0575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRO FAMILY CHIROPRACTIC CENTER, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-14",
        "last_updated": "2008-07-14",
        "status": "A",
        "authorized_official_last_name": "PROVENZA-TABAK",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "DOCTOR OF CHIROPRACTIC",
        "authorized_official_telephone_number": "330-702-0500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "OH",
            "license": "2661",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2062888",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Ann Popio
• Holli Marie Poulakos, L.M.T., N.M.T.
• Tammara Marie Poullas
• Judith A Prickett, CNP, APRN
• Primary Care Specialists, Inc.
• Professional Dental Alliance
• Professional Dental Alliance
• Professional Dental Alliance LLC
• Lisa M Provenza-Tabak, D.C.
• Psy Care Inc

• Chiropractor in Canfield, OH
• Providers in Canfield, OH by specialty
• Chiropractor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2008; 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.