Healthcare Provider Details

I. General information

NPI: 1750552451
Provider Name (Legal Business Name): FALL CREEK CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2008
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11780 OLIO RD STE 200
FISHERS IN
46037-7617
US

IV. Provider business mailing address

11780 OLIO ROAD, SUITE 200
FISHERS IN
46037
US

V. Phone/Fax

Practice location:
  • Phone: 317-577-1744
  • Fax: 317-577-1760
Mailing address:
  • Phone: 317-577-1744
  • Fax: 317-577-1760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002187A
License Number State

VIII. Authorized Official

Name: DR. DEAN E WIGGERS
Title or Position: OWNER
Credential: D.C..
Phone: 317-577-1744