Healthcare Provider Details

I. General information

NPI: 1124086251
Provider Name (Legal Business Name): ERIC MICHAEL WEST D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BREWFIELD DR
WAPAKONETA OH
45895-9394
US

IV. Provider business mailing address

801 BREWFIELD DR
WAPAKONETA OH
45895-9394
US

V. Phone/Fax

Practice location:
  • Phone: 419-738-4373
  • Fax: 419-738-3780
Mailing address:
  • Phone: 419-738-4373
  • Fax: 419-738-3780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number2518
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: