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General NPI Number Information
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NPI Number | 1497219299
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Entity Type | Organization
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Legal Business Name | HOMEGROWN CHIROPRACTIC & WELLNESS LLC
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Dates
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Enumeration Date | 01/25/2019
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Last Update Date | 01/25/2019
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Provider Practice Location Address
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Address Line | 1204 E DOROTHY LN
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City | DAYTON
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State | OH
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Zip | 45419-2111
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Country | US
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Telephone | 937-479-7930
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Fax |
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Provider Business Mailing Address
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Address Line | 3050 SEARS RD
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City | SPRING VALLEY
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State | OH
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Zip | 45370-7726
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Country | US
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Telephone | 937-479-7930
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Fax |
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Authorized Official
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Title or Position | OWNER CHIROPRACTOR
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Name | LINZIE CRUTE
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Credential | DC
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Telephone | 937-479-7930
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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 |
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License Number State |
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