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Chiropractic Providers Chiropractor Sports Physician

Provider NPI: 1245363696

Provider Information:
Gender: M
Not Sole Proprietor

Practice Location:
1709 E BRISTOL ST  ELKHART, IN 46514-6606 US
Tel: 574-264-9174  Fax: 574-262-4070

Business Mailing Address:
1709 E. BRISTOL ST.  ELKHART, IN 46514-6606 US
Tel: 574-264-9174  Fax: 574-262-4070

NPI Information:
NPI: 1245363696
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y111NS0005XChiropractic Providers
Sports Physician

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 111NS0005X





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