Provider Demographics
NPI:1750883260
Name:ANTHONY WAYNE COMMUNITY CHIROPRACTIC LLC
Entity type:Organization
Organization Name:ANTHONY WAYNE COMMUNITY CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:HOLLERBACH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-309-3800
Mailing Address - Street 1:10345 WATERVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:OH
Mailing Address - Zip Code:43571-9176
Mailing Address - Country:US
Mailing Address - Phone:419-419-3800
Mailing Address - Fax:
Practice Address - Street 1:10345 WATERVILLE ST
Practice Address - Street 2:
Practice Address - City:WHITEHOUSE
Practice Address - State:OH
Practice Address - Zip Code:43571-9176
Practice Address - Country:US
Practice Address - Phone:419-419-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty