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General NPI Number Information
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NPI Number | 1467608125
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Entity Type | Organization
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Legal Business Name | PREMIER SPORTS CHIROPRACTIC OF GEIST
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 08/13/2008
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Provider Practice Location Address
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Address Line | 8924 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9648
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Country | US
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Telephone | 317-841-2700
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Fax |
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Provider Business Mailing Address
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Address Line | 8924 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9648
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Country | US
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Telephone | 317-841-2700
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ANDREW T HOFFMAN
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Credential | DC
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Telephone | 317-841-2700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 08002336A
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License Number State | IN
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