Healthcare Provider Details

I. General information

NPI: 1255455424
Provider Name (Legal Business Name): DRUMMOND CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4712 E STATE ROAD 46
BLOOMINGTON IN
47401-9201
US

IV. Provider business mailing address

4712 E STATE ROAD 46
BLOOMINGTON IN
47401-9201
US

V. Phone/Fax

Practice location:
  • Phone: 812-336-2423
  • Fax: 812-331-2792
Mailing address:
  • Phone: 812-336-2423
  • Fax: 812-331-2792

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001974A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001975A
License Number StateIN

VIII. Authorized Official

Name: DR. WILLIAMS DALLAS DRUMMOND
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 812-336-2423