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General NPI Number Information
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NPI Number | 1275825069
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Entity Type | Organization
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Legal Business Name | DC INTEGRATED MEDICINE CORPORATION
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Dates
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Enumeration Date | 05/11/2011
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 212 E 10TH ST
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City | GREENSBURG
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State | IN
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Zip | 47240-8249
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Country | US
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Telephone | 812-222-0970
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Fax | 812-222-0972
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Provider Business Mailing Address
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Address Line | 212 E 10TH ST
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City | GREENSBURG
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State | IN
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Zip | 47240-8249
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Country | US
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Telephone | 812-222-0970
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Fax | 812-222-0972
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Authorized Official
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Title or Position | PRESIDENT/PRACTITIONER
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Name | DR. ANDREW CHANDLER
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Credential | D.O.
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Telephone | 812-222-0970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 02003584A
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License Number State | IN
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