Healthcare Provider Details

I. General information

NPI: 1710594486
Provider Name (Legal Business Name): DEMKO GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 MICHAEL DR STE E
CHESTERTON IN
46304-2695
US

IV. Provider business mailing address

6908 W 200 N
LA PORTE IN
46350-9734
US

V. Phone/Fax

Practice location:
  • Phone: 219-921-2095
  • Fax: 219-533-4014
Mailing address:
  • Phone: 219-508-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MARGARET DEMKO
Title or Position: OFFICE COORDINATOR
Credential:
Phone: 219-508-4154