Healthcare Provider Details

I. General information

NPI: 1841438884
Provider Name (Legal Business Name): DRACH CHIROPRACTIC, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

708 N PLYMOUTH RD
WINAMAC IN
46996-7641
US

IV. Provider business mailing address

P.O. BOX 193
WINAMAC IN
46996-0193
US

V. Phone/Fax

Practice location:
  • Phone: 574-946-7764
  • Fax: 574-946-7769
Mailing address:
  • Phone: 574-946-7764
  • Fax: 574-946-7769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002203A
License Number StateIN

VIII. Authorized Official

Name: PHILLIP W BORUFF
Title or Position: OWNER/PRESIDENT
Credential: D.C.
Phone: 574-946-7764