Healthcare Provider Details

I. General information

NPI: 1275529000
Provider Name (Legal Business Name): COMMUNITY ARTS CHIROPRACTIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6326 RUCKER RD STE F
INDIANAPOLIS IN
46220-4889
US

IV. Provider business mailing address

6326 RUCKER RD STE F
INDIANAPOLIS IN
46220-4889
US

V. Phone/Fax

Practice location:
  • Phone: 317-253-1644
  • Fax: 317-536-0456
Mailing address:
  • Phone: 317-253-1644
  • Fax: 317-536-0456

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08002179A
License Number StateIN

VIII. Authorized Official

Name: DECHEZ ALMONT EDMONDS
Title or Position: ASSOCIATE
Credential: DC
Phone: 317-253-1644