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General NPI Number Information
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NPI Number | 1902856610
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Entity Type | Organization
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Legal Business Name | FORT WAYNE CHIROPRACTIC, INC.
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Dates
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Enumeration Date | 05/11/2006
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Last Update Date | 04/20/2011
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Provider Practice Location Address
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Address Line | 340 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2048
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Country | US
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Telephone | 260-489-6019
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Fax | 260-489-6136
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Provider Business Mailing Address
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Address Line | 340 E DUPONT RD
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City | FORT WAYNE
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State | IN
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Zip | 46825-2048
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Country | US
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Telephone | 260-489-6019
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Fax | 260-489-6136
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Authorized Official
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Title or Position | CEO
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Name | DR. TIMOTHY A SWIHART
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Credential | CHIROPRACTOR
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Telephone | 260-489-6019
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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 | 08001362A
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License Number State | IN
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