Healthcare Provider Details

I. General information

NPI: 1124941646
Provider Name (Legal Business Name): DOMINIC X LITCHFIELD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 W 14TH ST
INDIANAPOLIS IN
46202-2369
US

IV. Provider business mailing address

115 BRANDYWINE LN
DECATUR IN
46733-2601
US

V. Phone/Fax

Practice location:
  • Phone: 317-274-5555
  • Fax:
Mailing address:
  • Phone: 260-223-6863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: