Basic Information
| Provider Information | |||||||||
| NPI: | 1770670317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HURLEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | D.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1020 PORTAGE TRL | ||||||||
| Address2: | |||||||||
| City: | CUYAHOGA FALLS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 442213032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3309284747 | ||||||||
| FaxNumber: | 3302309700 | ||||||||
| Practice Location | |||||||||
| Address1: | 1790 TOWN PARK BLVD | ||||||||
| Address2: | SUITE F | ||||||||
| City: | UNIONTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 446857972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3308999863 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/06/2006 | ||||||||
| LastUpdateDate: | 12/22/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111NX0800X | 1567 | OH | Y | Chiropractic Providers | Chiropractor | Orthopedic |
ID Information
| ID | Type | State | Issuer | Description | 0985215 | 05 | OH | MEDICAID |