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General NPI Number Information
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NPI Number | 1689820946
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Entity Type | Organization
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Legal Business Name | WYANDOT CHIROPRACTIC & FITNESS INC.
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Dates
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Enumeration Date | 08/18/2008
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Last Update Date | 05/21/2020
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Provider Practice Location Address
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Address Line | 109 HOUPT DR
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City | UPPER SANDUSKY
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State | OH
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Zip | 43351-9201
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Country | US
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Telephone | 419-294-3489
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Fax | 419-294-2791
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Provider Business Mailing Address
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Address Line | 109 HOUPT DR
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City | UPPER SANDUSKY
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State | OH
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Zip | 43351-9201
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Country | US
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Telephone | 419-294-3489
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Fax | 419-294-2791
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Authorized Official
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Title or Position | DOCTOR OF CHIROPRACTIC
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Name | DR. MATTHEW EUGENE THIEL
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Credential | DC
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Telephone | 419-294-3489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 1102
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License Number State | OH
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