Healthcare Provider Details
I. General information
NPI: 1033304191
Provider Name (Legal Business Name): SELAND CHIROPRACTIC CENTER, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 09/12/2007
Last Update Date: 09/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7350 VILLAGE SQUARE LN
FISHERS IN
46038-4555
US
IV. Provider business mailing address
7350 VILLAGE SQUARE LANE
FISHERS IN
46038-4555
US
V. Phone/Fax
- Phone: 317-598-1410
- Fax: 317-598-9807
- Phone: 317-598-1410
- Fax: 317-598-9807
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 111N00000X |
| Taxonomy | Chiropractor |
| License Number | |
| License Number State | IN |
VIII. Authorized Official
Name: DR.
TROND
G
SELAND
I
Title or Position: PRESIDENT
Credential: DC
Phone: 317-598-1410