Healthcare Provider Details

I. General information

NPI: 1821287731
Provider Name (Legal Business Name): COOL CREEK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 05/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14747 OAK ROAD BLD 3 SUITE 300
CARMEL IN
46033
US

IV. Provider business mailing address

14747 OAK RD SUITE 300
CARMEL IN
46033-8183
US

V. Phone/Fax

Practice location:
  • Phone: 317-818-1414
  • Fax:
Mailing address:
  • Phone: 317-818-1414
  • Fax: 317-818-1014

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002343A
License Number StateIN

VIII. Authorized Official

Name: DR. GRANT ROMINE
Title or Position: MEMBER
Credential: D.C.
Phone: 317-818-1414