MEDICARE: ANCHORED CHIROPRACTIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1144867623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANCHORED CHIROPRACTIC LLC

Provider Business Mailing Address
First Line	:	1930 PEARL RD UNIT B
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-558-1119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1930 PEARL RD UNIT B
Second Line	:
City	:	BRUNSWICK
State	:	OH
Zip	:	44212-6477
Country	:	US
Telephone Number	:	330-558-1119
Fax Number	:

Authorized Official
Title or Position	:	OWNER/CHIROPRACTOR
Name	:	DR. ASHLEY ELIZABETH WUNDERLE
Credential	:	DC
Telephone Number	:	330-558-1119

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/04/2019

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