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General NPI Number Information
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NPI Number | 1871357913
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Entity Type | Organization
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Legal Business Name | MIDWEST CHIROPRACTIC & REHAB
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Dates
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Enumeration Date | 02/08/2024
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Last Update Date | 03/24/2024
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Provider Practice Location Address
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Address Line | 208 W 20TH ST
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2850
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Country | US
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Telephone | 765-825-3521
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Fax | 765-825-8554
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Provider Business Mailing Address
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Address Line | 208 W 20TH ST
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City | CONNERSVILLE
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State | IN
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Zip | 47331-2850
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Country | US
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Telephone | 765-825-3521
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Fax | 765-825-8554
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Authorized Official
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Title or Position | CEO
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Name | DR. CLAY TENBARGE
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Credential | DC
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Telephone | 765-825-3521
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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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