Provider Demographics
NPI:1376746826
Name:MUCK, DAVID EDWIN (DC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:EDWIN
Last Name:MUCK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2526 PERRYSBURG HOLLAND RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1344
Mailing Address - Country:US
Mailing Address - Phone:419-866-0462
Mailing Address - Fax:
Practice Address - Street 1:2526 PERRYSBURG HOLLAND RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1344
Practice Address - Country:US
Practice Address - Phone:419-866-0462
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor