Healthcare Provider Details

I. General information

NPI: 1306447313
Provider Name (Legal Business Name): HOFFERTH CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

826 W EDISON RD
MISHAWAKA IN
46545-2744
US

IV. Provider business mailing address

PO BOX 6206
SOUTH BEND IN
46660-6206
US

V. Phone/Fax

Practice location:
  • Phone: 574-256-1008
  • Fax:
Mailing address:
  • Phone: 574-256-1008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: GERARD HOFFERTH
Title or Position: OWNER
Credential: D.C.
Phone: 574-256-1008