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General NPI Number Information
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NPI Number | 1447213442
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Entity Type | Individual
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Provider Name | DAN J RECORD
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Gender | Male
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Dates
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Enumeration Date | 04/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8404 SIEAR TER
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City | INDIANAPOLIS
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State | IN
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Zip | 46227-7215
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Country | US
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Telephone | 317-887-7050
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Fax |
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Provider Business Mailing Address
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Address Line | 8180 CLEARVISTA PKWY 230
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City | INDIANAPOLIS
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State | IN
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Zip | 46256-5629
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34003910A
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License Number State | IN
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