Healthcare Provider Details

I. General information

NPI: 1588696702
Provider Name (Legal Business Name): JOSEPH A TARGONSKI DC DM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 EAST LUTZ ROAD
ARCHBOLD OH
43502-0302
US

IV. Provider business mailing address

305 EAST LUTZ ROAD PO BOX 302
ARCHBOLD OH
43502-0302
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
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37-00-3457
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: