Provider Demographics
NPI:1932373875
Name:NITSCHKE CHIROPRACTIC WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:NITSCHKE CHIROPRACTIC WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NITSCHKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-300-9790
Mailing Address - Street 1:1275 GREENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-9352
Mailing Address - Country:US
Mailing Address - Phone:419-300-9790
Mailing Address - Fax:419-300-9789
Practice Address - Street 1:1275 GREENVILLE RD
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:OH
Practice Address - Zip Code:45885-9352
Practice Address - Country:US
Practice Address - Phone:419-300-9790
Practice Address - Fax:419-300-9789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3590111N00000X
225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2561400Medicaid
OHSP4156281Medicare PIN
OH2561400Medicaid