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General NPI Number Information
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NPI Number | 1932197092
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Entity Type | Individual
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Provider Name | JULIE SUZANNE DETWILER D.C.
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Gender | Female
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 12/04/2007
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Provider Practice Location Address
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Address Line | 8231 MAIN ST
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City | KINSMAN
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State | OH
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Zip | 44428-9514
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Country | US
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Telephone | 330-876-1111
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Fax | 330-876-1005
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Provider Business Mailing Address
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Address Line | 8231 MAIN ST P.O. BOX 393
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City | KINSMAN
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State | OH
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Zip | 44428-9514
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Country | US
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Telephone | 330-876-1111
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Fax | 330-876-1005
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 2992
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License Number State | OH
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