Basic Information
| Provider Information | |||||||||
| NPI: | 1174520001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATTAGLIA | ||||||||
| FirstName: | ANTHONY | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 762 S CLEVELAND MASSILLON RD | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306654100 | ||||||||
| FaxNumber: | 3306654190 | ||||||||
| Practice Location | |||||||||
| Address1: | 762 S CLEVELAND MASSILLON RD | ||||||||
| Address2: | |||||||||
| City: | FAIRLAWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 443333024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3306654100 | ||||||||
| FaxNumber: | 3306654190 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NR0400X | 1019 | OH | Y | Chiropractic Providers | Chiropractor | Rehabilitation |
ID Information
| ID | Type | State | Issuer | Description | 0926949 | 05 | OH | MEDICAID |