Healthcare Provider Details

I. General information

NPI: 1255684684
Provider Name (Legal Business Name): CHIROPRACTIC 419 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6546 WEATHERFIELD CT STE C1
MAUMEE OH
43537-9255
US

IV. Provider business mailing address

6546 WEATHERFIELD CT STE C1
MAUMEE OH
43537-9255
US

V. Phone/Fax

Practice location:
  • Phone: 419-720-1472
  • Fax: 419-720-1475
Mailing address:
  • Phone: 419-720-1472
  • Fax: 419-720-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2089
License Number StateOH

VIII. Authorized Official

Name: JEFFREY LEE KOEPFLER
Title or Position: MEMBER/DOCTOR
Credential: DC
Phone: 419-720-1472