Healthcare Provider Details

I. General information

NPI: 1891846283
Provider Name (Legal Business Name): ANALEPTIC ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 01/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5015 RIVIERA CT
FORT WAYNE IN
46825-5805
US

IV. Provider business mailing address

5015 RIVIERA CT
FORT WAYNE IN
46825-5805
US

V. Phone/Fax

Practice location:
  • Phone: 260-484-9321
  • Fax: 260-484-9321
Mailing address:
  • Phone: 260-484-9321
  • Fax: 260-484-9321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08000376A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number07000302A
License Number StateIN

VIII. Authorized Official

Name: DR. OTIS DEE ORR III
Title or Position: PHYSICIAN PRESIDENT
Credential: DPM DC
Phone: 260-484-9321