Healthcare Provider Details

I. General information

NPI: 1730359308
Provider Name (Legal Business Name): MISKELLY CHIROPRACTIC CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 LOWER HUNTINGTON RD
FORT WAYNE IN
46809-2616
US

IV. Provider business mailing address

2811 LOWER HUNTINGTON RD
FORT WAYNE IN
46809-2616
US

V. Phone/Fax

Practice location:
  • Phone: 260-747-1596
  • Fax: 260-747-1597
Mailing address:
  • Phone: 260-747-1596
  • Fax: 260-747-1597

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number08000497A
License Number StateIN

VIII. Authorized Official

Name: DR. WILLIAM J MISKELLY
Title or Position: PRESIDENT
Credential: D. C.
Phone: 260-747-1596