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General NPI Number Information
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NPI Number | 1710211792
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Entity Type | Organization
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Legal Business Name | CHIRO 1ST PC OF INDIANA
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Dates
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Enumeration Date | 09/24/2009
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Last Update Date | 09/24/2009
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Provider Practice Location Address
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Address Line | 11020 E 10TH ST UNIT B
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3710
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Country | US
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Telephone | 317-898-5800
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Fax | 317-898-5883
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Provider Business Mailing Address
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Address Line | 11020 E 10TH ST UNIT B
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3710
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Country | US
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Telephone | 317-898-5800
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Fax | 317-898-5883
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Authorized Official
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Title or Position | SEC/TREAS - OFFICE MANAGER
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Name | JULIAN SANGALANG
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Credential |
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Telephone | 317-898-5800
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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 | 01017401A
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License Number State | IN
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