Organization
MUNGOVAN CHIROPRACTIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL THOMAS MUNGOVAN DC (OWNER)
(260) 447-1067
Entity
Organization
Contact information
Practice address
4705 ILLINOIS RD STE 102, FORT WAYNE, IN 46804-5108
(260) 447-1067
(260) 447-0827
Mailing address
4705 ILLINOIS RD STE 102, FORT WAYNE, IN 46804-5108
(260) 447-1067
(260) 447-0827
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08001044
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
226000A
MEDICARE PTAN
IN
Enumeration date
05/03/2007
Last updated
04/09/2013
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