MEDICARE: SHADELAND CHIROPRACTIC

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	261QP3300X	Pain Clinic/Center	08001268A	IN

General Provider Information

NPI Number	:	1649499906
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHADELAND CHIROPRACTIC

Provider Business Mailing Address
First Line	:	PO BOX 19839
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-0839
Country	:	US
Telephone Number	:	317-352-1516
Fax Number	:	317-356-5178

Provider Business Practice Location Address
First Line	:	1841 N SHADELAND AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-2735
Country	:	US
Telephone Number	:	317-352-1516
Fax Number	:	317-356-5178

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TRAVIS VIC BARNHART
Credential	:	D.C.
Telephone Number	:	317-352-1516

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	08/22/2020

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Directions to “SHADELAND CHIROPRACTIC ” Practice Location

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