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General NPI Number Information
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NPI Number | 1508148131
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Entity Type | Organization
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Legal Business Name | MONTGOMERY COUNTY CHIROPRACTIC CLINIC LLC
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Dates
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Enumeration Date | 09/09/2011
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Last Update Date | 09/09/2011
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Provider Practice Location Address
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Address Line | 1408 DARLINGTON AVE SUITE G
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-2056
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Country | US
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Telephone | 765-359-3330
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Fax | 765-359-3332
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Provider Business Mailing Address
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Address Line | 1408 DARLINGTON AVE SUITE G
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City | CRAWFORDSVILLE
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State | IN
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Zip | 47933-2056
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Country | US
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Telephone | 765-359-3330
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Fax | 765-359-3332
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | DR. ANTHONY STEVEN EDGECOMBE
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Credential | D.C.
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Telephone | 765-359-3330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 08002570A
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License Number State | IN
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