Great Lakes Physical Medicine LLC

Primary specialty

ChiropractorTaxonomy code 111N00000X

Legal business name

GREAT LAKES PHYSICAL MEDICINE LLC

Practice address

25200 Chagrin Blvd Ste 103
Beachwood, OH 44122-5681

Phone

(570) 575-5414

NPI assigned

Feb 8, 2020

Organization subpart

No

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

Authorized official

Name

Eric D Wolk, DC

Title

Owner

Phone

(570) 575-5414

Specialties & licenses 2

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1581120000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581120000000",
    "number": "1356973267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25200 CHAGRIN BLVD STE 103",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225681",
            "telephone_number": "570-575-5414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25200 CHAGRIN BLVD STE 103",
            "city": "BEACHWOOD",
            "state": "OH",
            "postal_code": "441225681",
            "telephone_number": "570-575-5414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES PHYSICAL MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-08",
        "last_updated": "2020-02-08",
        "certification_date": "2020-02-08",
        "status": "A",
        "authorized_official_last_name": "WOLK",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "570-575-5414",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0281891",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darren Lee Graves, CDCA
• Kellie Renae Graves, OTR/L
• Gray and Hornstein, DDS Inc
• Rasheda Gray
• Great Lakes Care Inc
• Greater Cleveland Home Health Care Inc
• Greater Cleveland Optometry LLC
• Greater Cleveland Pediatrics
• Green Road Behavioral Health, Inc.
• Joann L Green, MSW

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.