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General NPI Number Information
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NPI Number | 1225441231
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Entity Type | Organization
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Legal Business Name | PINE VALLEY CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 06/06/2014
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Last Update Date | 09/12/2022
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Provider Practice Location Address
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Address Line | 10330 COLDWATER RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2033
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Country | US
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Telephone | 352-514-0767
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Fax |
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Provider Business Mailing Address
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Address Line | 10330 COLDWATER RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2033
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Country | US
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Telephone | 260-203-4062
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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. MATTHEW HOUCHIN
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Credential | DC
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Telephone | 563-381-7370
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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 | 08002736A
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License Number State | IN
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