Healthcare Provider Details

I. General information

NPI: 1912622093
Provider Name (Legal Business Name): LAFAYETTE CHIROPRACTIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2022
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3778 UNION ST.
LAFAYETTE IN
47905-4453
US

IV. Provider business mailing address

3778 UNION ST.
LAFAYETTE IN
47905-4453
US

V. Phone/Fax

Practice location:
  • Phone: 765-448-1674
  • Fax: 765-449-0847
Mailing address:
  • Phone: 765-448-1674
  • Fax: 765-449-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code111NP0017X
TaxonomyPediatric Chiropractor
License Number
License Number State

VIII. Authorized Official

Name: DAVID ALAN BOWMAN
Title or Position: OWNER
Credential: DC
Phone: 765-448-1674