Healthcare Provider Details

I. General information

NPI: 1992624415
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL DEWALD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9610 LIMA ROAD STE 104
FORT WAYNE IN
46818
US

IV. Provider business mailing address

16310 THUNDERBIRD RD
HUNTERTOWN IN
46748-9369
US

V. Phone/Fax

Practice location:
  • Phone: 260-209-5568
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08003548A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: