Healthcare Provider Details

I. General information

NPI: 1568441392
Provider Name (Legal Business Name): LARRY R SPIELES DC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 N MAIN ST
MINSTER OH
45865-9537
US

IV. Provider business mailing address

3845 STATE ROUTE 119
MINSTER OH
45865-9720
US

V. Phone/Fax

Practice location:
  • Phone: 419-628-2718
  • Fax: 419-628-3850
Mailing address:
  • Phone: 419-628-2717
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number114
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: