Provider Demographics
NPI:1366750028
Name:NIERMAN CHIROPRACTIC AND WELLNESS LLC
Entity type:Organization
Organization Name:NIERMAN CHIROPRACTIC AND WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:904-527-9601
Mailing Address - Street 1:1921 HUGHES DR
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46816-3102
Mailing Address - Country:US
Mailing Address - Phone:904-527-9601
Mailing Address - Fax:
Practice Address - Street 1:1921 HUGHES DR
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46816-3102
Practice Address - Country:US
Practice Address - Phone:904-527-9601
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-15
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002640A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center