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General NPI Number Information
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NPI Number | 1699381525
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Entity Type | Organization
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Legal Business Name | EXCELLENCE CHIROPRACTIC & WELLNESS, LLC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 06/15/2021
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Provider Practice Location Address
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Address Line | 10298 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9497
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Country | US
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Telephone | 317-747-0088
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Fax |
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Provider Business Mailing Address
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Address Line | 10298 E 96TH ST
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City | FISHERS
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State | IN
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Zip | 46037-9497
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Country | US
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Telephone | 317-747-0088
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Fax |
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Authorized Official
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Title or Position | OWNER, CHIROPRACTOR
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Name | DR. MICHAEL MACKENZIE GEARHEART
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Credential | BS, DC
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Telephone | 765-499-8376
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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 |
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License Number State |
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