Provider Demographics
NPI:1225441231
Name:PINE VALLEY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:PINE VALLEY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:HOUCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:563-381-7370
Mailing Address - Street 1:10330 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-2033
Mailing Address - Country:US
Mailing Address - Phone:260-203-4062
Mailing Address - Fax:
Practice Address - Street 1:10330 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-2033
Practice Address - Country:US
Practice Address - Phone:352-514-0767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2022-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002736A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty