MEDICARE: ALLEN COUNTY FAMILY & SPORTS CHIROPRACTIC

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	111NN1001X	Nutrition Chiropractor	08001638	IN
2	111NS0005X	Sports Physician Chiropractor	08001622	IN

General Provider Information

NPI Number	:	1205933165
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALLEN COUNTY FAMILY & SPORTS CHIROPRACTIC

Provider Business Mailing Address
First Line	:	3835 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6809
Country	:	US
Telephone Number	:	260-432-7339
Fax Number	:

Provider Business Practice Location Address
First Line	:	3835 W JEFFERSON BLVD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-6809
Country	:	US
Telephone Number	:	260-432-7339
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. MONIQUE LILLIAN MARIE LEVESQUE-HARTLE
Credential	:	D.C.
Telephone Number	:	260-432-7339

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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Directions to “ALLEN COUNTY FAMILY & SPORTS CHIROPRACTIC ” Practice Location

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