Provider Demographics
NPI:1801928254
Name:NEEDLER, JOHN R (DC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:NEEDLER
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 1:11010 STATE ROUTE 12
Mailing Address - Street 2:P.O. BOX 73
Mailing Address - City:COLUMBUS GROVE
Mailing Address - State:OH
Mailing Address - Zip Code:45830-9287
Mailing Address - Country:US
Mailing Address - Phone:419-659-2176
Mailing Address - Fax:419-659-2176
Practice Address - Street 1:11010 STATE ROUTE 12
Practice Address - Street 2:
Practice Address - City:COLUMBUS GROVE
Practice Address - State:OH
Practice Address - Zip Code:45830-9287
Practice Address - Country:US
Practice Address - Phone:419-659-2176
Practice Address - Fax:419-659-2176
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH813111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0591677Medicaid
OHNE0499101Medicare ID - Type Unspecified