Healthcare Provider Details

I. General information

NPI: 1881098655
Provider Name (Legal Business Name): ALLISONVILLE INTEGRATIVE HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2014
Last Update Date: 10/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11521 FISHERS DR
FISHERS IN
46038-1860
US

IV. Provider business mailing address

11521 FISHERS DR
FISHERS IN
46038-1860
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-1188
  • Fax: 317-842-8522
Mailing address:
  • Phone: 317-842-1188
  • Fax: 317-842-8522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002786A
License Number StateIN

VIII. Authorized Official

Name: DR. CLAYTON CHRISTOPHER FREY
Title or Position: DOCTOR OF CHIROPRACTIC
Credential: D.C., B.S.
Phone: 219-308-6577