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General NPI Number Information
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NPI Number | 1235487901
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Entity Type | Organization
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Legal Business Name | HEALTHSOURCE CHIROPRACTIC OF WESTFIELD LLC
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Dates
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Enumeration Date | 08/28/2012
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Last Update Date | 11/25/2014
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Provider Practice Location Address
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Address Line | 785 E MAIN ST
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City | WESTFIELD
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State | IN
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Zip | 46074-9440
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Country | US
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Telephone | 317-757-9442
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Fax |
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Provider Business Mailing Address
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Address Line | 785 E MAIN ST
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City | WESTFIELD
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State | IN
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Zip | 46074-9440
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Country | US
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Telephone | 317-757-9442
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Fax | 318-804-8300
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Authorized Official
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Title or Position | OWNER
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Name | DR. STACEY YOUNG
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Credential | DC
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Telephone | 317-757-9442
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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 | 08002515A
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License Number State | IN
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