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General NPI Number Information
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NPI Number | 1104107374
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Entity Type | Organization
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Legal Business Name | CRAWFORDSVILLE CHIROPRACTIC, LLC
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Dates
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Enumeration Date | 09/01/2011
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Last Update Date | 01/31/2015
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Provider Practice Location Address
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Address Line | 407 E MARKET ST STE 102
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-1852
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Country | US
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Telephone | 765-362-1500
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Fax | 765-361-8919
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Provider Business Mailing Address
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Address Line | 407 E MARKET ST STE 102
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-1852
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Country | US
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Telephone | 765-362-1500
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Fax | 765-361-8919
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY R MCINTYRE
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Credential | D.C.
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Telephone | 765-362-1500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002470A
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License Number State | IN
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