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General NPI Number Information
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NPI Number | 1306068283
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Entity Type | Organization
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Legal Business Name | POELKING CHIROPRACTIC WELLNESS & PHYSICAL THERAPY, INC.
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2660 WOODMAN CENTER CT
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City | DAYTON
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State | OH
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Zip | 45420-1477
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Country | US
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Telephone | 937-299-2900
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Fax | 937-299-9640
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Provider Business Mailing Address
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Address Line | 8648 CYPRESS TRL
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City | WAYNESVILLE
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State | OH
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Zip | 45068-8361
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Country | US
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Telephone | 937-885-6110
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. THEODORE J POELKING
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Credential | D.C.
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Telephone | 937-299-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NR0400X
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Taxonomy Name | Rehabilitation Chiropractor
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License Number | 2199
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License Number State | OH
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