Provider Demographics
NPI:1770052615
Name:PROPOLIS 1624
Entity type:Organization
Organization Name:PROPOLIS 1624
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CORY
Authorized Official - Middle Name:JOE
Authorized Official - Last Name:MEULEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:419-615-3114
Mailing Address - Street 1:9263 OH-12
Mailing Address - Street 2:
Mailing Address - City:FINDLAY
Mailing Address - State:OH
Mailing Address - Zip Code:45840
Mailing Address - Country:US
Mailing Address - Phone:419-581-7975
Mailing Address - Fax:
Practice Address - Street 1:9263 OH-12
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840
Practice Address - Country:US
Practice Address - Phone:419-581-7975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-21
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty