=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568599231
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JDN ENTERPRISES INCORPORATED
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2007
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2808 MITCHELL RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47421-5318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-275-0500
-----------------------------------------------------
Fax | 812-275-3500
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2808 MITCHELL RD
-----------------------------------------------------
City | BEDFORD
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 47421-5318
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 812-275-0500
-----------------------------------------------------
Fax | 812-275-3500
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JASON D NOTTGER
-----------------------------------------------------
Credential | DC
-----------------------------------------------------
Telephone | 812-275-0500
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 81000080A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | 08002094A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------