=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336267822
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTRAL CHIROPRACTIC ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/26/2007
-----------------------------------------------------
Last Update Date | 08/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 N JIM DAY RD
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167-7218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-883-1444
-----------------------------------------------------
Fax | 812-883-8119
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 522
-----------------------------------------------------
City | SALEM
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47167-0522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-883-1444
-----------------------------------------------------
Fax | 812-883-8119
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. TED J FREIDLINE
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 812-883-1444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------