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General NPI Number Information
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NPI Number | 1457681587
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN INDIANA SPINE & REHAB CENTER LLC
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Dates
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Enumeration Date | 01/12/2010
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Last Update Date | 05/24/2010
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Provider Practice Location Address
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Address Line | 24 SARATOGA DR
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City | BATESVILLE
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State | IN
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Zip | 47006-8482
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Country | US
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Telephone | 812-932-2399
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Fax | 812-932-2398
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Provider Business Mailing Address
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Address Line | 24 SARATOGA DR
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City | BATESVILLE
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State | IN
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Zip | 47006-8482
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Country | US
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Telephone | 812-932-2399
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Fax | 812-932-2398
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ADAM J. MAPLE
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Credential | D.C.
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Telephone | 812-932-2399
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 08002494A
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License Number State | IN
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