MEDICARE: DUPONT CHIROPRACTIC RESOURCE CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184929010
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUPONT CHIROPRACTIC RESOURCE CENTER INC.

Provider Business Mailing Address
First Line	:	1960 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1582
Country	:	US
Telephone Number	:	260-489-2266
Fax Number	:	260-490-6565

Provider Business Practice Location Address
First Line	:	1960 E DUPONT RD
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1582
Country	:	US
Telephone Number	:	260-489-2266
Fax Number	:	260-490-6565

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TERRY W. WEIMER
Credential	:	D.C.
Telephone Number	:	260-489-2266

Provider Enumeration Date	:	01/25/2011
Last Update Date	:	08/22/2013

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