Healthcare Provider Details

I. General information

NPI: 1184020497
Provider Name (Legal Business Name): HOFFMAN SPORTS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 12/17/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11521 FISHERS DR
FISHERS IN
46038-1860
US

IV. Provider business mailing address

PO BOX 410
CARMEL IN
46082-0410
US

V. Phone/Fax

Practice location:
  • Phone: 317-213-1246
  • Fax: 317-842-8522
Mailing address:
  • Phone: 317-213-1246
  • Fax: 317-842-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002336A
License Number StateIN

VIII. Authorized Official

Name: ANDREW T HOFFMAN
Title or Position: OWNER
Credential: DC
Phone: 317-213-1246