Countryside Clinic of Chiropractic, LLC

NPI #1063837367 in Lebanon, Ohio

Provider Information

NPI Number: 1063837367
Entity Type: Organization
Organization Name: Countryside Clinic of Chiropractic, LLC
Primary Specialty: Chiropractor
Enumeration Date: Feb 23, 2014
Last Updated: Nov 26, 2019

Practice Location

Address: 990 BELVEDERE DR STE B
City: Lebanon
State: Ohio
ZIP Code: 45036-1193
Phone: (513) 836-8844

Authorized Official

Name: DR. TONY DEJTIRANUKUL, D.C.
Title: OWNER
Phone: (314) 496-6030

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Chiropractor	111N00000X	Primary

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