Provider Demographics
NPI:1710102702
Name:NORWALK FAMILY CHIROPRACTIC
Entity Type:Organization
Organization Name:NORWALK FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:WITHERELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-663-9500
Mailing Address - Street 1:35 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:OH
Mailing Address - Zip Code:44857-2152
Mailing Address - Country:US
Mailing Address - Phone:419-663-9500
Mailing Address - Fax:
Practice Address - Street 1:35 E WATER ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:OH
Practice Address - Zip Code:44857-2152
Practice Address - Country:US
Practice Address - Phone:419-663-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3385111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical ExaminerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000331582OtherANTHEM
OH539486817001OtherMEDICAL MUTUAL
OH000000331582OtherANTHEM