Provider Demographics
NPI:1750198362
Name:VARCKETTE, AMY MAE (DC)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:MAE
Last Name:VARCKETTE
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 1:5013 STATE ROUTE 307 E
Mailing Address - Street 2:
Mailing Address - City:GENEVA
Mailing Address - State:OH
Mailing Address - Zip Code:44041-9616
Mailing Address - Country:US
Mailing Address - Phone:440-415-3817
Mailing Address - Fax:
Practice Address - Street 1:1956 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-6424
Practice Address - Country:US
Practice Address - Phone:440-992-0160
Practice Address - Fax:440-998-0121
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHDC-05408111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor