MEDICARE: SHADELAND CHIROPRACTIC & WELLNESS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NR0200X	Radiology Chiropractor		IN
2	111N00000X	Chiropractor		IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PR28574220001	OTHER	IN	CIGNA
2	000000090849	OTHER	IN	ANTHEM

General Provider Information

NPI Number	:	1356544738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADELAND CHIROPRACTIC & WELLNESS

Provider Business Mailing Address
First Line	:	1841 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2735
Country	:	US
Telephone Number	:	317-352-1516
Fax Number	:

Provider Business Practice Location Address
First Line	:	1841 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2735
Country	:	US
Telephone Number	:	317-352-1516
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. TRAVIS V BARNHART
Credential	:	D.C.
Telephone Number	:	317-352-1516

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/21/2022

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Directions to “SHADELAND CHIROPRACTIC & WELLNESS ” Practice Location

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