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NPI Code Detail

MEDICARE: FORT WAYNE CHIROPRACTIC, INC.

MEDICARE: FORT WAYNE CHIROPRACTIC, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1111N00000XChiropractor08001362AIN

General Provider Information

NPI Number : 1902856610
Entity Type Code : Organization
Provider Name (Legal Business Name) : FORT WAYNE CHIROPRACTIC, INC.
Provider Business Mailing Address
First Line : 340 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-2048
Country : US
Telephone Number : 260-489-6019
Fax Number : 260-489-6136
Provider Business Practice Location Address
First Line : 340 E DUPONT RD
Second Line :
City : FORT WAYNE
State : IN
Zip : 46825-2048
Country : US
Telephone Number : 260-489-6019
Fax Number : 260-489-6136
Authorized Official
Title or Position : CEO
Name : DR. TIMOTHY A SWIHART
Credential : CHIROPRACTOR
Telephone Number : 260-489-6019
Provider Enumeration Date : 05/11/2006
Last Update Date : 04/20/2011

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Directions to “FORT WAYNE CHIROPRACTIC, INC. ” Practice Location

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