Healthcare Provider Details

I. General information

NPI: 1639331556
Provider Name (Legal Business Name): ALLISONVILLE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2008
Last Update Date: 04/01/2013
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 Code302R00000X
TaxonomyHealth Maintenance Organization
License Number08001184
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number0800184
License Number StateIN

VIII. Authorized Official

Name: JOSEPH MICHAEL KUNZER
Title or Position: DC
Credential:
Phone: 317-842-1188