Healthcare Provider Details

I. General information

NPI: 1649410630
Provider Name (Legal Business Name): MICHAEL JUSTIN NAGEL D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BREWFIELD DR. REDSKIN TRAIL
WAPAKONETA OH
45895
US

IV. Provider business mailing address

801 BREWFIELD DR. REDSKIN TRAIL
WAPAKONETA OH
45895
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 Number3973
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: