Healthcare Provider Details

I. General information

NPI: 1992921530
Provider Name (Legal Business Name): REGIONAL CHIROPRACTIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2136 N COOPER ST
KOKOMO IN
46901-1697
US

IV. Provider business mailing address

2136 N COOPER ST
KOKOMO IN
46901-1697
US

V. Phone/Fax

Practice location:
  • Phone: 765-452-0888
  • Fax: 765-452-6288
Mailing address:
  • Phone: 765-452-0888
  • Fax: 765-452-6288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001690A
License Number StateIN

VIII. Authorized Official

Name: DR. WAYNE B LADD
Title or Position: OWNER
Credential: D.C.
Phone: 765-452-0888