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General NPI Number Information
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NPI Number | 1194057885
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Entity Type | Organization
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Legal Business Name | WATERVILLE CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 02/04/2010
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Last Update Date | 02/04/2010
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Provider Practice Location Address
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Address Line | 216 SOUTH ST
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City | WATERVILLE
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State | OH
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Zip | 43566-1463
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Country | US
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Telephone | 419-878-8142
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Fax |
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Provider Business Mailing Address
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Address Line | 216 SOUTH ST
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City | WATERVILLE
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State | OH
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Zip | 43566-1463
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Country | US
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Telephone | 419-878-8142
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Fax | 419-878-8143
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Authorized Official
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Title or Position | MANAGER
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Name | DR. JON W SCHWANZ
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Credential | DC
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Telephone | 419-878-8142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NT0100X
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Taxonomy Name | Thermography Chiropractor
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License Number | 1201
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License Number State | OH
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