MEDICARE: INDIANAPOLIS INTEGRATIVE HEALTH AND REHABILITATION 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

General Provider Information

NPI Number	:	1639546070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDIANAPOLIS INTEGRATIVE HEALTH AND REHABILITATION INC

Provider Business Mailing Address
First Line	:	55 S STATE AVE
Second Line	:	SUITE 201
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-638-3111
Fax Number	:	317-672-7540

Provider Business Practice Location Address
First Line	:	55 S STATE AVE
Second Line	:	SUITE 201
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46201-3802
Country	:	US
Telephone Number	:	317-638-3111
Fax Number	:	317-672-7540

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ANGELICA C EKIN
Credential	:
Telephone Number	:	317-454-2147

Provider Enumeration Date	:	09/01/2015
Last Update Date	:	09/01/2015

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