Healthcare Provider Details

I. General information

NPI: 1215028592
Provider Name (Legal Business Name): JEFFREY DANIEL DETTWILER D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9865 E 116TH ST SUITE 150
FISHERS IN
46037-9231
US

IV. Provider business mailing address

9865 E 116TH ST STE 150
FISHERS IN
46037-9239
US

V. Phone/Fax

Practice location:
  • Phone: 317-902-5802
  • Fax:
Mailing address:
  • Phone: 317-902-5802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002271A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: