Healthcare Provider Details

I. General information

NPI: 1225190028
Provider Name (Legal Business Name): HEALTHY CONNECTIONS HOLISTIC HEALTH CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 CENTRAL AVE
BATESVILLE IN
47006-8917
US

IV. Provider business mailing address

279 CENTRAL AVE
BATESVILLE IN
47006-8917
US

V. Phone/Fax

Practice location:
  • Phone: 812-932-3999
  • Fax: 812-932-3998
Mailing address:
  • Phone: 812-932-3999
  • Fax: 812-932-3998

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State

VIII. Authorized Official

Name: CLINTON S DODGE
Title or Position: VICE PRESIDENT
Credential: DC
Phone: 812-932-3999