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General NPI Number Information
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NPI Number | 1194909937
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Entity Type | Organization
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Legal Business Name | MIDWEST MUA LLC
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Dates
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Enumeration Date | 12/27/2007
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Last Update Date | 12/27/2007
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Provider Practice Location Address
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Address Line | 2402 PRIMROSE DR
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City | VALPARAISO
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State | IN
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Zip | 46383-5958
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Country | US
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Telephone | 219-510-5312
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Fax |
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Provider Business Mailing Address
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Address Line | 2402 PRIMROSE DR
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City | VALPARAISO
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State | IN
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Zip | 46383-5958
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Country | US
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Telephone | 219-510-5312
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Fax |
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Authorized Official
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Title or Position | CHIROPRACTOR
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Name | DR. SCOTT JAMES BRAUN
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Credential | D.C.
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Telephone | 219-510-5312
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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 | 08002287A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 01040540A
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License Number State | IN
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