Healthcare Provider Details

I. General information

NPI: 1568599231
Provider Name (Legal Business Name): JDN ENTERPRISES INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 02/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2808 MITCHELL RD
BEDFORD IN
47421-5318
US

IV. Provider business mailing address

2808 MITCHELL RD
BEDFORD IN
47421-5318
US

V. Phone/Fax

Practice location:
  • Phone: 812-275-0500
  • Fax: 812-275-3500
Mailing address:
  • Phone: 812-275-0500
  • Fax: 812-275-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002094A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81000080A
License Number StateIN

VIII. Authorized Official

Name: DR. JASON D NOTTGER
Title or Position: OWNER
Credential: DC
Phone: 812-275-0500