Healthcare Provider Details

I. General information

NPI: 1336557776
Provider Name (Legal Business Name): PURE FAMILY CHIROPRACTIC CARMEL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/29/2014
Last Update Date: 07/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2776 E 146TH ST
CARMEL IN
46033-7718
US

IV. Provider business mailing address

2776 E 146TH ST
CARMEL IN
46033-7718
US

V. Phone/Fax

Practice location:
  • Phone: 317-587-1900
  • Fax: 317-245-2111
Mailing address:
  • Phone: 317-587-1900
  • Fax: 317-245-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002653A
License Number StateIN

VIII. Authorized Official

Name: GARY R EYLER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 317-587-1900