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General NPI Number Information
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NPI Number | 1255532800
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Entity Type | Organization
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Legal Business Name | PACELLI CHIROPRACTIC HEALTH POTENTIAL COMPLEX INC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 12/11/2023
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Provider Practice Location Address
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Address Line | 40 PROFESSIONAL CT
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City | LAFAYETTE
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State | IN
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Zip | 47905-5152
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Country | US
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Telephone | 765-447-2222
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Fax | 765-447-7051
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Provider Business Mailing Address
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Address Line | 40 PROFESSIONAL CT
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City | LAFAYETTE
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State | IN
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Zip | 47905-5152
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Country | US
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Telephone | 765-447-2222
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Fax | 765-447-7051
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Authorized Official
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Title or Position | COMPLEX MANAGER
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Name | MRS. BRANDY LADD
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Credential |
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Telephone | 765-447-2222
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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 | 0800547
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 84000029A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08001812A
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License Number State | IN
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