Healthcare Provider Details

I. General information

NPI: 1063116630
Provider Name (Legal Business Name): HURST CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

209 3RD AVE
JASPER IN
47546-3427
US

IV. Provider business mailing address

209 3RD AVE
JASPER IN
47546-3427
US

V. Phone/Fax

Practice location:
  • Phone: 812-482-4269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CALEB HURST
Title or Position: PRESIDENT
Credential:
Phone: 812-482-4269