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General NPI Number Information
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NPI Number | 1518726017
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Entity Type | Organization
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Legal Business Name | SANDUSKY CHIROPRACTIC CENTER PLLC
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Dates
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Enumeration Date | 03/18/2024
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Last Update Date | 03/18/2024
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Provider Practice Location Address
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Address Line | 418 WOODLAND DR
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City | SANDUSKY
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State | MI
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Zip | 48471-1047
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Country | US
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Telephone | 810-648-2820
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Fax | 810-648-4717
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Provider Business Mailing Address
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Address Line | 418 WOODLAND DR
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City | SANDUSKY
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State | MI
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Zip | 48471-1047
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Country | US
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Telephone | 810-648-2820
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Fax | 810-648-4717
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Authorized Official
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Title or Position | OWNER
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Name | NICOLA I JAKSA
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Credential | DC
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Telephone | 810-392-7373
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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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