Healthcare Provider Details

I. General information

NPI: 1124233978
Provider Name (Legal Business Name): NICHOLAS BERNARD JANSEN D.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 11/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 BROAD RIPPLE AVE SUITE 9
INDIANAPOLIS IN
46220-2363
US

IV. Provider business mailing address

1810 BROAD RIPPLE AVE SUITE 9
INDIANAPOLIS IN
46220-2363
US

V. Phone/Fax

Practice location:
  • Phone: 317-251-1800
  • Fax: 317-251-1801
Mailing address:
  • Phone: 317-251-1800
  • Fax: 317-251-1801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002328A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81000088A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: