NPIMap

Organization Active NPI

Physical Medicine and Chiropractic Rehabilitation LLC

  • Chiropractor
  • Euclid, OH
National Provider Identifier
1720141013
Registry record updated Aug 29, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PHYSICAL MEDICINE AND CHIROPRACTIC REHABILITATION LLC
Practice address
22308 Lakeshore Blvd
Euclid, OH 44123
Phone
(216) 289-2500
Fax
(216) 289-2585
NPI assigned
Dec 18, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2019

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

Authorized official

Name
Dr. Marc J Rosenberg, DCNPI 1073629382
Title
Owner
Phone
(216) 289-2500

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
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

22308 Lakeshore Blvd
Euclid, OH 44123

Mailing address

22308 Lakeshore Blvd
Euclid, OH 44123
Phone (216) 289-2500

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090506000209 OH Part B Supplier - Clinic/Group Practice 4486702107 Receives reassigned benefits from 2 practitioners
Practice locations: Euclid, OH

National Provider Directory

National Provider Directory

Locations

22308 Lake Shore Blvd
Euclid, OH 44123
Phone (216) 289-2500

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1567036800000",
    "number": "1720141013",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22308 LAKESHORE BLVD",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "44123",
            "telephone_number": "216-289-2500",
            "fax_number": "216-289-2585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22308 LAKESHORE BLVD",
            "city": "EUCLID",
            "state": "OH",
            "postal_code": "44123",
            "telephone_number": "216-289-2500",
            "fax_number": "216-289-2585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHYSICAL MEDICINE AND CHIROPRACTIC REHABILITATION LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-18",
        "last_updated": "2019-08-29",
        "status": "A",
        "authorized_official_last_name": "ROSENBERG",
        "authorized_official_first_name": "MARC",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "216-289-2500",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Euclid, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2019; 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.