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General NPI Number Information
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NPI Number | 1376876730
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Entity Type | Organization
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Legal Business Name | INDIANAPOLIS SPORT AND SPINE, P.C.
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Dates
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Enumeration Date | 09/16/2009
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Last Update Date | 09/16/2009
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Provider Practice Location Address
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Address Line | 1460 N GREEN ST SUITE 400
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City | BROWNSBURG
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State | IN
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Zip | 46112-7487
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Country | US
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Telephone | 317-852-2005
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Fax | 317-852-2353
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Provider Business Mailing Address
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Address Line | 1460 N GREEN ST SUITE 400
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City | BROWNSBURG
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State | IN
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Zip | 46112-7487
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JASON WELSH
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Credential | D.C.
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Telephone | 317-852-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NS0005X
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Taxonomy Name | Sports Physician Chiropractor
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License Number | 08002455A
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License Number State | IN
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