Healthcare Provider Details

I. General information

NPI: 1700445665
Provider Name (Legal Business Name): IDEAL CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2019
Last Update Date: 06/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 SAWMILL PKWY STE 3
HURON OH
44839-2284
US

IV. Provider business mailing address

404 WEXFORD DR
HURON OH
44839-1463
US

V. Phone/Fax

Practice location:
  • Phone: 419-602-1978
  • Fax:
Mailing address:
  • Phone: 419-602-1978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON PAUL KRUEGER
Title or Position: MAJORITY MANAGER
Credential: DC
Phone: 419-602-1978