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General NPI Number Information
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NPI Number | 1669893954
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Entity Type | Organization
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Legal Business Name | INDY FAMILY CHIROPRACTIC LLC
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Dates
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Enumeration Date | 01/03/2014
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Last Update Date | 10/22/2025
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Provider Practice Location Address
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Address Line | 3940 W 96TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2922
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Country | US
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Telephone | 317-749-0677
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Fax |
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Provider Business Mailing Address
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Address Line | 3940 W 96TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46268-2922
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Country | US
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Telephone | 317-749-0677
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Fax | 317-735-8753
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Authorized Official
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Title or Position | DOCTOR/OWNER
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Name | DR. NICKOLAS SCOTT WILSON
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Credential | DC
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Telephone | 317-749-0677
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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 | 08002708A
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License Number State | IN
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