Healthcare Provider Details

I. General information

NPI: 1154587483
Provider Name (Legal Business Name): WARDS CORNER CHIROPRACTIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2008
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 WARDS CORNER RD. SUITE 101
LOVELAND OH
45140-6149
US

IV. Provider business mailing address

550 WARDS CORNER RD. SUITE 101
LOVELAND OH
45140-6149
US

V. Phone/Fax

Practice location:
  • Phone: 513-677-6787
  • Fax: 513-677-2260
Mailing address:
  • Phone: 513-677-6787
  • Fax: 513-677-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DR. DOUGLAS R PORTMANN
Title or Position: OWNER
Credential:
Phone: 513-677-6787