Healthcare Provider Details

I. General information

NPI: 1528160637
Provider Name (Legal Business Name): JOSEPH A. TARGONSKI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 02/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 EAST LUTZ ROAD
ARCHBOLD OH
43502
US

IV. Provider business mailing address

305 EAST LUTZ ROAD P O BOX 302
ARCHBOLD OH
43502
US

V. Phone/Fax

Practice location:
  • Phone: 419-446-2591
  • Fax: 419-446-0230
Mailing address:
  • Phone: 419-446-2591
  • Fax: 419-446-0230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number345
License Number StateOH

VIII. Authorized Official

Name: MRS. JOYCE A TARGONSKI
Title or Position: OFFICE MANAGER
Credential:
Phone: 419-446-2591