Healthcare Provider Details

I. General information

NPI: 1871250639
Provider Name (Legal Business Name): MAHONY-RATHBURN CHIROPRACTIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2021
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8422 UNION CHAPEL RD.
FT. WAYNE IN
46845
US

IV. Provider business mailing address

7021 GARMAN RD.
AUBURN IN
46706
US

V. Phone/Fax

Practice location:
  • Phone: 260-319-1126
  • Fax: 260-627-0772
Mailing address:
  • Phone: 260-319-1126
  • Fax: 260-627-0772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateNULL

VIII. Authorized Official

Name: KAMI L. RATHBURN MAHONY
Title or Position: PRESIDENT
Credential: D.C.
Phone: 260-687-0542