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General NPI Number Information
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NPI Number | 1093978736
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Entity Type | Organization
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Legal Business Name | CHAMPION CHIROPRACTIC LLC
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Dates
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Enumeration Date | 07/02/2008
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Last Update Date | 07/02/2008
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Provider Practice Location Address
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Address Line | 7135 SYLVANIA AVE BLDG 1-B
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City | SYLVANIA
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State | OH
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Zip | 43560-5510
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Country | US
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Telephone | 419-841-3273
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 FAWN HOLLOW RD
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City | TOLEDO
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State | OH
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Zip | 43617-1859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER MARIE HAINES
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Credential | DC
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Telephone | 412-779-6745
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 3855
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License Number State | OH
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