Healthcare Provider Details

I. General information

NPI: 1043343171
Provider Name (Legal Business Name): SOUTHERN INDIANA CHIROPRACTIC & REHABILITATION CENTER, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 12/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5120 CHARLESTOWN RD
NEW ALBANY IN
47150-9497
US

IV. Provider business mailing address

5120 CHARLESTOWN RD
NEW ALBANY IN
47150-9497
US

V. Phone/Fax

Practice location:
  • Phone: 812-944-8000
  • Fax: 812-944-8992
Mailing address:
  • Phone: 812-944-8000
  • Fax: 812-944-8992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number08001418
License Number StateIN

VIII. Authorized Official

Name: PAUL B DENIS
Title or Position: CHIROPRACTOR
Credential: D.C.
Phone: 812-944-8000