Organization Active NPI

Richfield Chiropractic Center LLC

  • Sports Physician Chiropractor
  • Richfield, OH
National Provider Identifier
1386002889
Registry record updated Jan 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Sports Physician ChiropractorTaxonomy code 111NS0005X
License
991 Issued in OH
Legal business name
RICHFIELD CHIROPRACTIC CENTER LLC
Practice address
4028 Broadview Rd
Richfield, OH 44286-9230
Phone
(330) 659-4955
Fax
(330) 659-6052
NPI assigned
Jan 29, 2016
Last updated
Jan 29, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 29, 2016

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

Authorized official

Name
Dr. Gary Cramer Domanick, D.CNPI 1336285188
Title
Managing Member
Phone
(330) 659-4955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Sports Physician Chiropractor 111NS0005X 991 OH Primary

Addresses

Primary practice location

4028 Broadview Rd
Richfield, OH 44286-9230

Mailing address

4028 Broadview Rd
Richfield, OH 44286-9230
Phone (330) 659-4955

Other identifiers 1

IdentifierTypeStateIssuer
0541382MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160316000847 OH Part B Supplier - Clinic/Group Practice 0345546420 Receives reassigned benefits from 1 practitioner
Practice locations: Richfield, OH

National Provider Directory

National Provider Directory

Locations

4028 Broadview Rd
Richfield, OH 44286
Phone (330) 659-4955

4028 Broadview Rd
Ste C
Richfield, OH 44286
Phone (330) 659-4955

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1454025600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1454025600000",
    "number": "1386002889",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4028 BROADVIEW RD",
            "city": "RICHFIELD",
            "state": "OH",
            "postal_code": "442869230",
            "telephone_number": "330-659-4955",
            "fax_number": "330-659-6052"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4028 BROADVIEW RD",
            "city": "RICHFIELD",
            "state": "OH",
            "postal_code": "442869230",
            "telephone_number": "330-659-4955",
            "fax_number": "330-659-6052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHFIELD CHIROPRACTIC CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-29",
        "last_updated": "2016-01-29",
        "status": "A",
        "authorized_official_last_name": "DOMANICK",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "CRAMER",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "330-659-4955",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "OH",
            "license": "991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0541382",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Richfield, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2016; 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.