MEDICARE: AFFORDABLE CHIROPRACTIC CLINIC LLC

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	08002401A	IN

General Provider Information

NPI Number	:	1629369319
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFORDABLE CHIROPRACTIC CLINIC LLC

Provider Business Mailing Address
First Line	:	5703 S EAST ST
Second Line	:	SUITE H
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1989
Country	:	US
Telephone Number	:	317-757-8166
Fax Number	:	317-757-8422

Provider Business Practice Location Address
First Line	:	5703 S EAST ST
Second Line	:	SUITE H
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1989
Country	:	US
Telephone Number	:	317-757-8166
Fax Number	:	317-757-8422

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOEL MATTHEW CARSON
Credential	:	DC
Telephone Number	:	317-757-8166

Provider Enumeration Date	:	04/28/2011
Last Update Date	:	04/28/2011

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