Healthcare Provider Details

I. General information

NPI: 1568698678
Provider Name (Legal Business Name): CHIROPRACTIC WELLNESS CENTER OF INDIANA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 EXECUTIVE DR SUITE J
CARMEL IN
46032-2995
US

IV. Provider business mailing address

75 EXECUTIVE DR SUITE J
CARMEL IN
46032-2995
US

V. Phone/Fax

Practice location:
  • Phone: 317-575-9310
  • Fax: 317-575-8423
Mailing address:
  • Phone: 317-575-9310
  • Fax: 317-575-8423

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001094
License Number StateIN

VIII. Authorized Official

Name: DR. SANDRA K CUNNINGHAM
Title or Position: DOCTOR OF CHIROPRACTIC
Credential:
Phone: 317-575-9310