Healthcare Provider Details

I. General information

NPI: 1831392307
Provider Name (Legal Business Name): CICERO CHIROPRACTIC INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 S PERU ST
CICERO IN
46034-9687
US

IV. Provider business mailing address

209 S PERU ST
CICERO IN
46034-9687
US

V. Phone/Fax

Practice location:
  • Phone: 317-984-3578
  • Fax: 317-984-3410
Mailing address:
  • Phone: 317-984-3578
  • Fax: 317-984-3410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001594
License Number StateIN

VIII. Authorized Official

Name: DR. TERESA ANN LEWIS
Title or Position: OWNER
Credential: D.C.
Phone: 317-984-3578