| NPI | 1962854802 |
|---|---|
| Former Legal Business Name | ROOT CAUSE MEDICAL CLINIC INC |
| Entity Type | Organization |
| Authorized Contact | JORDAN MATTHEW AXE Owner/President 937-216-9048 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Additional Taxonomies | 111N00000X Chiropractor |
| 207L00000X Anesthesiology | |
| 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism | |
| 225100000X Physical Therapist | |
| 363A00000X Physician Assistant | |
| 363L00000X Nurse Practitioner | |
| 363LA2200X Nurse Practitioner, Adult Health | |
| 363LF0000X Nurse Practitioner, Family | |
| 363LG0600X Nurse Practitioner, Gerontology | |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2023-02-23 |