Provider Demographics
NPI:1710005020
Name:NITSCHKE, LON H (DC)
Entity type:Individual
Prefix:DR
First Name:LON
Middle Name:H
Last Name:NITSCHKE
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 1:421 WEST MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WOODVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43469
Mailing Address - Country:US
Mailing Address - Phone:419-849-2414
Mailing Address - Fax:419-849-2050
Practice Address - Street 1:421 W MAIN STREET
Practice Address - Street 2:
Practice Address - City:WOODVILLE
Practice Address - State:OH
Practice Address - Zip Code:43469
Practice Address - Country:US
Practice Address - Phone:419-849-2414
Practice Address - Fax:419-849-2050
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1804111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHN10718952Medicare ID - Type Unspecified