1689820946 NPI number — WYANDOT CHIROPRACTIC & FITNESS INC.

Table of content: ELYSE MARIE LOVE M.S. (NPI 1609141845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689820946 NPI number — WYANDOT CHIROPRACTIC & FITNESS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WYANDOT CHIROPRACTIC & FITNESS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1689820946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
109 HOUPT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UPPER SANDUSKY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43351-9201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-294-3489
Provider Business Mailing Address Fax Number:
419-294-2791

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 HOUPT DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UPPER SANDUSKY
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43351-9201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-294-3489
Provider Business Practice Location Address Fax Number:
419-294-2791
Provider Enumeration Date:
08/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
THIEL
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
DOCTOR OF CHIROPRACTIC
Authorized Official Telephone Number:
419-294-3489

Provider Taxonomy Codes

  • Taxonomy code: 111NS0005X , with the licence number:  1102 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000121332 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2795088 . This is a "MEDICAID (INDIVIDUAL)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: $$$$$$$$$ . This is a "SOCIAL SECURITY NUMBER" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1821004052 . This is a "NPI (INDIVIDUAL)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 273645910002 . This is a "MEDICAL MUTUAL OF OHIO" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2882911 . This is a "MEDICAID (GROUP)" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 5840453 . This is a "OLD AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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