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General NPI Number Information
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NPI Number | 1194867127
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Entity Type | Organization
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Legal Business Name | JDN ENTERPRISES INCORPORATED
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Dates
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Enumeration Date | 02/13/2007
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Last Update Date | 12/15/2020
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Provider Practice Location Address
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Address Line | 2808 MITCHELL RD
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City | BEDFORD
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State | IN
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Zip | 47421-5318
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Country | US
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Telephone | 812-275-0500
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Fax | 812-275-3500
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Provider Business Mailing Address
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Address Line | 2808 MITCHELL RD
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City | BEDFORD
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State | IN
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Zip | 47421-5318
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Country | US
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Telephone | 812-275-0500
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DEBRA S MALOTT
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Credential |
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Telephone | 812-275-0500
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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 | 08002094A
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License Number State | IN
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