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General NPI Number Information
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NPI Number | 1346526480
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Entity Type | Organization
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Legal Business Name | BOONE COUNTY CHIROPRACTIC OFFICE, PC
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Dates
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Enumeration Date | 11/02/2011
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Last Update Date | 11/16/2011
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Provider Practice Location Address
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Address Line | 3920 N STATE ROAD 39
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City | LEBANON
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State | IN
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Zip | 46052-9389
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Country | US
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Telephone | 765-482-1610
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Fax | 765-482-9659
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Provider Business Mailing Address
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Address Line | 3920 N STATE ROAD 39
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City | LEBANON
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State | IN
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Zip | 46052-9389
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Country | US
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Telephone | 765-482-1610
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Fax | 765-482-9659
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RUSSELL ALLEN LINDNER
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Credential | DR. OF CHIROPRACTIC
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Telephone | 765-482-1610
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 08000854A
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License Number State | IN
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