Healthcare Provider Details

I. General information

NPI: 1760525067
Provider Name (Legal Business Name): LAGRANGE WELLNESS CHIROPRACTOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2005 S HIGHWAY 53 STE C
LAGRANGE KY
40031-9109
US

IV. Provider business mailing address

PO BOX 457
LAGRANGE KY
40031-0457
US

V. Phone/Fax

Practice location:
  • Phone: 812-330-0909
  • Fax: 812-330-0099
Mailing address:
  • Phone: 812-330-0909
  • Fax: 812-330-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARA CONDER
Title or Position: BILLING MANAGER
Credential:
Phone: 812-330-0909