Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of October 4, 2026.
NPIDirectory

Countryside Clinic of Chiropractic, LLC

Organization Chiropractor · NPI 1063837367

Countryside Clinic of Chiropractic, LLC provides Chiropractor services in Lebanon, Ohio. Licensed in Ohio. Registered with an NPI since 2014.

Licensed in
OH
In the registry since
2014
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

990 Belvedere Dr Ste B
Lebanon, OH 45036-1193
Phone: (513) 836-8844
Fax: (513) 836-8845
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Chiropractor (primary) Taxonomy 111N00000X · Licence 4008 (OH)

Record details

NPI number1063837367
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Tony Dejtiranukul — Owner · (314) 496-6030
NPI enumeratedFebruary 23, 2014
Last updated in NPPESNovember 26, 2019
Mailing address990 Belvedere Dr Ste B, Lebanon, OH 45036-1193

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