Healthcare Provider Details

I. General information

NPI: 1750571568
Provider Name (Legal Business Name): MARTINSVILLE CHIROPRACTIC CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2007
Last Update Date: 01/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 E MORGAN ST
MARTINSVILLE IN
46151-1640
US

IV. Provider business mailing address

690 E MORGAN ST
MARTINSVILLE IN
46151-1640
US

V. Phone/Fax

Practice location:
  • Phone: 765-342-2208
  • Fax: 765-342-2327
Mailing address:
  • Phone: 765-342-2208
  • Fax: 765-342-2327

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001309
License Number StateIN

VIII. Authorized Official

Name: MICHAEL PHELPS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 765-342-2208