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General NPI Number Information
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NPI Number | 1730505355
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Entity Type | Organization
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Legal Business Name | MCCORDSVILLE HOLISTIC CHIROPRACTIC CENTER
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Dates
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Enumeration Date | 03/06/2014
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Last Update Date | 03/06/2014
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Provider Practice Location Address
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Address Line | 5649 N 800 W
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-9522
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Country | US
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Telephone | 317-926-9751
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Fax | 317-826-9761
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Provider Business Mailing Address
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Address Line | 5649 N 800 W
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City | MCCORDSVILLE
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State | IN
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Zip | 46055-9522
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Country | US
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Telephone | 317-826-9751
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Fax | 317-826-9761
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. MARY JO JOHNSON
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Credential | DC
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Telephone | 317-826-9751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111NN1001X
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Taxonomy Name | Nutrition Chiropractor
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License Number | 08001438A
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License Number State | IN
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