MEDICARE: CENTERVILLE CHIROPRACTIC I

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	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1518737287
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTERVILLE CHIROPRACTIC I

Provider Business Mailing Address
First Line	:	1127 ASHBURTON DR
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-1407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 S MAIN ST
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45458-2370
Country	:	US
Telephone Number	:	937-433-4800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL DUPLAIN
Credential	:	DC
Telephone Number	:	937-503-2073

Provider Enumeration Date	:	01/04/2024
Last Update Date	:	01/23/2024

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Directions to “CENTERVILLE CHIROPRACTIC I ” Practice Location

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