Healthcare Provider Details

I. General information

NPI: 1780861666
Provider Name (Legal Business Name): EAGLE CREEK CHIROPRACTIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2008
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 N HIGH SCHOOL RD
INDIANAPOLIS IN
46254-2709
US

IV. Provider business mailing address

3820 N HIGH SCHOOL RD
INDIANAPOLIS IN
46254-2709
US

V. Phone/Fax

Practice location:
  • Phone: 317-299-3330
  • Fax: 317-299-0404
Mailing address:
  • Phone: 317-299-3330
  • Fax: 317-299-0404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001056
License Number StateIN

VIII. Authorized Official

Name: DR. LUCAS PATRICK BROMLEY
Title or Position: PRESIDENT/OWNER
Credential: D.C.
Phone: 317-299-3330