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General NPI Number Information
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NPI Number | 1700445665
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Entity Type | Organization
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Legal Business Name | IDEAL CHIROPRACTIC LLC
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 2401 SAWMILL PKWY STE 3
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City | HURON
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State | OH
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Zip | 44839-2284
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Country | US
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Telephone | 419-602-1978
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Fax |
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Provider Business Mailing Address
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Address Line | 404 WEXFORD DR
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City | HURON
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State | OH
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Zip | 44839-1463
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Country | US
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Telephone | 419-602-1978
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Fax |
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Authorized Official
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Title or Position | MAJORITY MANAGER
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Name | DR. BRANDON PAUL KRUEGER
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Credential | DC
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Telephone | 419-602-1978
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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