MEDICARE: DR. JANE ANN HORMUTH D.C.

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	08001611	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	637-180	OTHER	IN	MEDICARE NUMBER

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	:	1568529311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE ANN HORMUTH D.C.

Provider Business Mailing Address
First Line	:	1111 S GREEN RIVER RD
Second Line	:	STE 104
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-6811
Country	:	US
Telephone Number	:	812-474-0704
Fax Number	:	812-909-0707

Provider Business Practice Location Address
First Line	:	1111 S GREEN RIVER RD
Second Line	:	SUITE 104
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-6811
Country	:	US
Telephone Number	:	812-474-0704
Fax Number	:	812-474-0704

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	08/11/2015

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