Healthcare Provider Details

I. General information

NPI: 1730164989
Provider Name (Legal Business Name): JOHN CHARLES ELKINS D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 09/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 W AUGLAIZE ST
WAPAKONETA OH
45895-1534
US

IV. Provider business mailing address

108 W AUGLAIZE ST
WAPAKONETA OH
45895-1534
US

V. Phone/Fax

Practice location:
  • Phone: 419-739-9000
  • Fax: 419-739-9005
Mailing address:
  • Phone: 419-739-9000
  • Fax: 419-739-9005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number3237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: