Provider Demographics
NPI:1144419524
Name:NYGREN FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NYGREN FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:NYGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-238-4387
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-0027
Mailing Address - Country:US
Mailing Address - Phone:419-238-4387
Mailing Address - Fax:419-238-4387
Practice Address - Street 1:118 1/2 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-1719
Practice Address - Country:US
Practice Address - Phone:419-238-4387
Practice Address - Fax:419-238-4387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2800111NN1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN1001XChiropractic ProvidersChiropractorNutritionGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000294842OtherANTHEM
OHSP02561Medicare PIN