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General NPI Number Information
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NPI Number | 1760268601
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Entity Type | Organization
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Legal Business Name | INDY SPINE & JOINT LLC
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Dates
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Enumeration Date | 09/06/2023
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 6865 PARKDALE PL STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5655
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Country | US
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Telephone | 317-388-4023
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Fax | 317-610-0716
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Provider Business Mailing Address
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Address Line | 6865 PARKDALE PL STE C
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-5655
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRANDON COLEMAN
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Credential |
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Telephone | 317-503-6329
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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