Healthcare Provider Details

I. General information

NPI: 1235456906
Provider Name (Legal Business Name): NIEKAMP CHIROPRACTIC CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 SOUTH EASTERN AVENUE
ST. HENRY OH
45883
US

IV. Provider business mailing address

PO BOX 416
SAINT HENRY OH
45883-0416
US

V. Phone/Fax

Practice location:
  • Phone: 419-763-1217
  • Fax: 419-763-1218
Mailing address:
  • Phone: 419-763-1217
  • Fax: 419-763-1218

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number3974
License Number StateOH

VIII. Authorized Official

Name: DR. ERIN GINA NIEKAMP
Title or Position: OWNER
Credential: D.C.
Phone: 419-763-1217