Healthcare Provider Details

I. General information

NPI: 1952524985
Provider Name (Legal Business Name): CHIROPRACTIC PHYSICIANS P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2007
Last Update Date: 10/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 W 450 N
SHIPSHEWANA IN
46565-9003
US

IV. Provider business mailing address

7960 W 450 N
SHIPSHEWANA IN
46565-9003
US

V. Phone/Fax

Practice location:
  • Phone: 260-768-4061
  • Fax: 260-768-4698
Mailing address:
  • Phone: 260-768-4061
  • Fax: 260-768-4698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number08001953A
License Number StateIN

VIII. Authorized Official

Name: DR. BENJAMIN LEE YOUNTS
Title or Position: CHEIF EXECUTIVE OFFICER
Credential: D.C., L.A.C.
Phone: 260-768-4061