Healthcare Provider Details

I. General information

NPI: 1174621841
Provider Name (Legal Business Name): TOTAL BODY CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E KIRACOFE AVE
ELIDA OH
45807-1031
US

IV. Provider business mailing address

10963 VAN WERT DECATUR RD
VAN WERT OH
45891-9211
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-2639
  • Fax: 419-227-2640
Mailing address:
  • Phone: 419-238-6686
  • Fax: 419-238-6201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: SHAD ALAN FOSTER
Title or Position: OWNER
Credential: D.C.
Phone: 419-238-6686