MEDICARE: NORTHEAST CHIROPRACTIC CENTER, INC

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	08002385A	IN

General Provider Information

NPI Number	:	1821335936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST CHIROPRACTIC CENTER, INC

Provider Business Mailing Address
First Line	:	4332 FLAGSTAFF CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4416
Country	:	US
Telephone Number	:	260-245-0460
Fax Number	:	260-245-0770

Provider Business Practice Location Address
First Line	:	4332 FLAGSTAFF CV
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46815-4416
Country	:	US
Telephone Number	:	260-245-0460
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ADAM S OSENGA
Credential	:	DC
Telephone Number	:	260-245-0460

Provider Enumeration Date	:	01/09/2013
Last Update Date	:	02/15/2022

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