Healthcare Provider Details

I. General information

NPI: 1801928254
Provider Name (Legal Business Name): JOHN R NEEDLER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11010 STATE ROUTE 12
COLUMBUS GROVE OH
45830-9287
US

IV. Provider business mailing address

11010 STATE ROUTE 12 P.O. BOX 73
COLUMBUS GROVE OH
45830-9287
US

V. Phone/Fax

Practice location:
  • Phone: 419-659-2176
  • Fax: 419-659-2176
Mailing address:
  • Phone: 419-659-2176
  • Fax: 419-659-2176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number813
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: