Healthcare Provider Details

I. General information

NPI: 1053533513
Provider Name (Legal Business Name): MIDWEST CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 05/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6104 HUNTLEY RD
COLUMBUS OH
43229-1004
US

IV. Provider business mailing address

6104 HUNTLEY RD
COLUMBUS OH
43229-1004
US

V. Phone/Fax

Practice location:
  • Phone: 614-847-9667
  • Fax: 614-847-9688
Mailing address:
  • Phone: 614-847-9667
  • Fax: 614-847-9688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number1454
License Number StateOH

VIII. Authorized Official

Name: DR. PETER J MANZ
Title or Position: MANAGER
Credential: D.C.
Phone: 614-847-9667