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General NPI Number Information
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NPI Number | 1508895426
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Entity Type | Organization
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Legal Business Name | ELKHART COUNTY CHIROPRACTIC
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Dates
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Enumeration Date | 07/02/2006
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Last Update Date | 10/01/2010
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Provider Practice Location Address
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Address Line | 909 LINWAY DR SUITE 1
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City | GOSHEN
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State | IN
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Zip | 46526-2431
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Country | US
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Telephone | 574-534-4400
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Fax | 574-534-5855
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Provider Business Mailing Address
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Address Line | 909 LINWAY DR SUITE 1
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City | GOSHEN
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State | IN
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Zip | 46526-2431
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Country | US
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Telephone | 574-534-4400
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Fax | 574-534-5855
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC OWNER
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Name | DR. BRENT FRANK LEWALLEN
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Credential | D.C.
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Telephone | 574-534-4400
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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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