Provider Demographics
NPI:1851662290
Name:KIEFER, MONICA (DC)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:KIEFER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13208 COUNTY ROAD 16 3
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9122
Mailing Address - Country:US
Mailing Address - Phone:419-343-8317
Mailing Address - Fax:
Practice Address - Street 1:13020 US HIGHWAY 20A
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9061
Practice Address - Country:US
Practice Address - Phone:419-343-8317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4249111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor