SPINE CENTER OF FORT WAYNE (NPI# 1417297839) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417297839 |
| Entity Type | Organization |
| Organization Name | SPINE CENTER OF FORT WAYNE |
| Practice Address |
3417 E State Blvd Fort Wayne IN 46805-4830 |
| Practice Telephone | 2603876218 |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2014-12-02 |
| Authorized Official Name | NATHAN SERMERSHEIM (CHIROPRACTOR) |
| Authorized Official Telephone | 2603876218 |
| Authorized Official Credential | D.C. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 111N00000X | Chiropractor | Chiropractic Providers |
| Street Address |
3417 E STATE BLVD |
| City | FORT WAYNE |
| State | IN |
| Zip Code | 46805-4830 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710533633 | Matthew Crawford | Chiropractor | 3417 E State Blvd, Fort Wayne, IN 46805-4830 | 2019-08-15 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619589546 | Connor Gemlick | Student in an Organized Health Care Education/Training Program | 1918 Carew St., Fort Wayne, IN 46805 | 2020-08-21 |
| 1710464086 | S.t.a.r. Care Services | Clinic/Center | 3521 Lake Avenue, Suite #4, Fort Wayne, IN 46805 | 2018-07-19 |
| 1083122865 | Noel Shafi | Counselor | 3010 East State Boulevard, Fort Wayne, IN 46805 | 2018-01-16 |
| 1063963627 | Toni L Irby | Specialist | 3219 E State Blvd, Fort Wayne, IN 46805 | 2016-10-19 |
| 1639626211 | Logan Schwerer | Pharmacist | 923 Northcrest Business Center 6d, Fort Wayne, IN 46805 | 2016-09-01 |
| 1063817104 | Michale Diane Rothgeb | Physical Therapy Assistant | 2200 Randollia Dr, Fort Wayne, IN 46805 | 2014-10-31 |
| 1124435789 | Julia I. Mcfann | Physical Therapist | 2200 Randalia Dr, Fort Wayne, IN 46805 | 2014-07-16 |
| 1083036974 | Capital Senior Living Properties 4, Inc. | Assisted Living Facility | 3320 East State Boulevard, Fort Wayne, IN 46805 | 2014-01-10 |
| 1356772396 | Alexander James Medical Supply | Durable Medical Equipment & Medical Supplies | 2200 Lake Avenue, Suite 290, Fort Wayne, IN 46805 | 2013-12-02 |
| 1043595689 | Randy James Jennings | Pharmacist | 923 Northcrest Business Center, 6-d, Fort Wayne, IN 46805 | 2011-10-14 |
| Find all providers in zip 46805 | ||||
| Taxonomy Code | 111N00000X |
| Grouping | Chiropractic Providers |
| Classification | Chiropractor |
| A provider qualified by a Doctor of Chiropractic (D.C.), licensed by the State and who practices chiropractic medicine -that discipline within the healing arts which deals with the nervous system and its relationship to the spinal column and its interrelationship with other body systems. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952891236 | Lindsay Mack | Chiropractor | 6121 Stoney Creek Dr, Fort Wayne, IN 46825-4408 | 2018-05-13 |
| 1114438595 | Anne Therese Venderley | Chiropractor | 6388 W Jefferson Blvd Ste B, Fort Wayne, IN 46804-3075 | 2017-10-12 |
| 1720506413 | Crossroads Wellness Center, LLC | Chiropractor | 9206 Lima Rd, Fort Wayne, IN 46818-1806 | 2017-09-01 |
| 1134575095 | New Life Health & Wellness Sw, LLC | Chiropractor | 10210 Chestnut Plaza Dr, Fort Wayne, IN 46814-8970 | 2016-05-10 |
| 1518359371 | Jennifer Michele Williams | Chiropractor | 122 E Collins Rd, Fort Wayne, IN 46825-5302 | 2015-03-03 |
| 1609209691 | Caleb Parker Suciu | Chiropractor | 1114 W. Cook Road, Fort Wayne, IN 46825 | 2013-08-14 |
| 1821335936 | Northeast Chiropractic Center, Inc | Chiropractor | 6633 E State Blvd, Ste 200, Fort Wayne, IN 46815-7010 | 2013-01-09 |
| 1558612929 | Chiropractic Care & Wellness Center, LLC | Chiropractor | 6388 W Jefferson Blvd, Suite B, Fort Wayne, IN 46804-3075 | 2012-09-26 |
| 1831475755 | Thomas Chiropractic | Chiropractor | 3162 Mallard Cove Ln, Fort Wayne, IN 46804-2882 | 2011-10-24 |
| 1215216072 | Sean F.c. Thomas | Chiropractor | 3158 Mallard Cove Ln, Fort Wayne, IN 46804-2882 | 2011-08-11 |
| Find all providers in FORT WAYNE | ||||
| City | FORT WAYNE |
| Zip Code | 46805 |
Please comment or provide details below to improve the information on SPINE CENTER OF FORT WAYNE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.