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General NPI Number Information
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NPI Number | 1962169268
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Entity Type | Organization
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Legal Business Name | OTTEMAN CHIROPRACTIC, PLLC
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Dates
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Enumeration Date | 11/21/2021
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Last Update Date | 11/21/2021
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Provider Practice Location Address
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Address Line | 1205 S WHITE CHAPEL BLVD STE 230
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9341
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Country | US
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Telephone | 817-224-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 S WHITE CHAPEL BLVD STE 100
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City | SOUTHLAKE
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State | TX
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Zip | 76092-9333
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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 | PRESIDENT
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Name | DR. MATTHEW JOHN OTTEMAN
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Credential | DC
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Telephone | 815-603-0325
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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 |
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License Number State |
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