=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023058336
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KIRKLING CHIROPRACTIC OFFICES PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2006
-----------------------------------------------------
Last Update Date | 05/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 30 SPRINGMILL COURT
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46158-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-831-3877
-----------------------------------------------------
Fax | 317-831-4748
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30 SPRINGMILL COURT
-----------------------------------------------------
City | MOORESVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46158-1790
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-831-3877
-----------------------------------------------------
Fax | 317-831-4748
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | MRS. JUDY L KIRKLING
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 317-831-3877
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 08000626A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------