Healthcare Provider Details

I. General information

NPI: 1790744761
Provider Name (Legal Business Name): ACUPUNCTURE AND CHIROPRACTIC CENTER OF INDIANAPOLIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 01/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4303 S EAST ST
INDIANAPOLIS IN
46227-1514
US

IV. Provider business mailing address

4303 S EAST ST
INDIANAPOLIS IN
46227-1514
US

V. Phone/Fax

Practice location:
  • Phone: 317-781-9636
  • Fax: 317-781-9635
Mailing address:
  • Phone: 317-781-9636
  • Fax: 317-781-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number81000010A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001826A
License Number StateIN

VIII. Authorized Official

Name: LAWRENCE H PAYTON
Title or Position: PRESIDENT
Credential: DC
Phone: 317-781-9636