Provider Demographics
NPI:1700445665
Name:IDEAL CHIROPRACTIC LLC
Entity type:Organization
Organization Name:IDEAL CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAJORITY MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:KRUEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-602-1978
Mailing Address - Street 1:404 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:HURON
Mailing Address - State:OH
Mailing Address - Zip Code:44839-1463
Mailing Address - Country:US
Mailing Address - Phone:419-602-1978
Mailing Address - Fax:
Practice Address - Street 1:2401 SAWMILL PKWY STE 3
Practice Address - Street 2:
Practice Address - City:HURON
Practice Address - State:OH
Practice Address - Zip Code:44839-2284
Practice Address - Country:US
Practice Address - Phone:419-602-1978
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-13
Last Update Date:2019-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center