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General NPI Number Information
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NPI Number | 1861106338
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Entity Type | Organization
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Legal Business Name | CLEAR CHIROPRACTIC SHELBYVILLE LLC
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Dates
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Enumeration Date | 01/10/2023
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Last Update Date | 01/10/2023
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Provider Practice Location Address
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Address Line | 502 SARAINA RD
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City | SHELBYVILLE
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State | IN
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Zip | 46176-1892
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Country | US
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Telephone | 317-669-6139
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Fax | 317-669-6139
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Provider Business Mailing Address
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Address Line | 609 N CHARLES ST
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City | PORTLAND
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State | IN
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Zip | 47371-3011
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Country | US
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Telephone | 260-726-3065
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Fax | 260-726-3406
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Authorized Official
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Title or Position | OWNER
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Name | STANTON COUCH
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Credential | DC
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Telephone | 260-726-3065
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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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