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General NPI Number Information
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NPI Number | 1669724795
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Entity Type | Organization
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Legal Business Name | MDTD, LLC
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Dates
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Enumeration Date | 10/13/2012
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Last Update Date | 10/13/2012
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Provider Practice Location Address
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Address Line | 26250 EUCLID AVE SUITE 771
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City | EUCLID
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State | OH
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Zip | 44132-3305
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Country | US
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Telephone | 330-697-6833
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Fax |
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Provider Business Mailing Address
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Address Line | 26250 EUCLID AVE SUITE 771
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City | EUCLID
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State | OH
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Zip | 44132-3305
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING
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Name | GARY WEINHAUER
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Credential |
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Telephone | 800-723-1880
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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 | DC3000
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License Number State | OH
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