Healthcare Provider Details

I. General information

NPI: 1679854186
Provider Name (Legal Business Name): LYDIA OGDEN D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2011
Last Update Date: 12/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 W MAIN ST
MOUNT ORAB OH
45154-8600
US

IV. Provider business mailing address

453 W MAIN ST
MOUNT ORAB OH
45154-8600
US

V. Phone/Fax

Practice location:
  • Phone: 937-444-6000
  • Fax: 937-444-6001
Mailing address:
  • Phone: 937-444-6000
  • Fax: 937-444-6001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4218
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: