Provider Demographics
NPI:1306447313
Name:HOFFERTH CHIROPRACTIC CENTER LLC
Entity type:Organization
Organization Name:HOFFERTH CHIROPRACTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFERTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-256-1008
Mailing Address - Street 1:PO BOX 6206
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46660-6206
Mailing Address - Country:US
Mailing Address - Phone:574-256-1008
Mailing Address - Fax:
Practice Address - Street 1:826 W EDISON RD
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-2744
Practice Address - Country:US
Practice Address - Phone:574-256-1008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty