Healthcare Provider Details

I. General information

NPI: 1467608125
Provider Name (Legal Business Name): PREMIER SPORTS CHIROPRACTIC OF GEIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2008
Last Update Date: 08/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8924 E 96TH ST
FISHERS IN
46037-9648
US

IV. Provider business mailing address

8924 E 96TH ST
FISHERS IN
46037-9648
US

V. Phone/Fax

Practice location:
  • Phone: 317-841-2700
  • Fax:
Mailing address:
  • Phone: 317-841-2700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number08002336A
License Number StateIN

VIII. Authorized Official

Name: ANDREW T HOFFMAN
Title or Position: PRESIDENT
Credential: DC
Phone: 317-841-2700