Healthcare Provider Details

I. General information

NPI: 1184015604
Provider Name (Legal Business Name): INJURY PROVIDER NETWORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5105 S US HIGHWAY 41 PMB 179
TERRE HAUTE IN
47802-4790
US

IV. Provider business mailing address

5105 S US HIGHWAY 41 PMB 179
TERRE HAUTE IN
47802-4790
US

V. Phone/Fax

Practice location:
  • Phone: 317-344-9580
  • Fax:
Mailing address:
  • Phone: 317-344-9580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. DION SNIDER
Title or Position: PROVIDER LIAISON
Credential: DC
Phone: 317-344-9580