Healthcare Provider Details

I. General information

NPI: 1225083934
Provider Name (Legal Business Name): KAREN LYNN BISESI D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EXECUTIVE DR STE J
CARMEL IN
46032-2993
US

IV. Provider business mailing address

75 EXECUTIVE DR STE J
CARMEL IN
46032-2993
US

V. Phone/Fax

Practice location:
  • Phone: 317-580-0000
  • Fax: 317-927-8621
Mailing address:
  • Phone: 317-580-0000
  • Fax: 317-927-8621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number080001647
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: