Provider Demographics
NPI:1356441133
Name:FT RECOVERY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:FT RECOVERY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHAD
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-238-6686
Mailing Address - Street 1:10963 VAN WERT DECATUR RD
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-9211
Mailing Address - Country:US
Mailing Address - Phone:419-238-6686
Mailing Address - Fax:419-238-6201
Practice Address - Street 1:103 EAST BROADWAY ST
Practice Address - Street 2:
Practice Address - City:FT RECOVERY
Practice Address - State:OH
Practice Address - Zip Code:45846-0655
Practice Address - Country:US
Practice Address - Phone:419-375-4558
Practice Address - Fax:419-375-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty