Healthcare Provider Details

I. General information

NPI: 1932373875
Provider Name (Legal Business Name): NITSCHKE CHIROPRACTIC WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 GREENVILLE RD
SAINT MARYS OH
45885-9352
US

IV. Provider business mailing address

1275 GREENVILLE RD
SAINT MARYS OH
45885-9352
US

V. Phone/Fax

Practice location:
  • Phone: 419-300-9790
  • Fax: 419-300-9789
Mailing address:
  • Phone: 419-300-9790
  • Fax: 419-300-9789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3590
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: LINDA NITSCHKE
Title or Position: OWNER
Credential:
Phone: 419-300-9790