MEDICARE: NATURALLY COMPLETE CHIROPRACTIC SPA

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	:	1710506282
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATURALLY COMPLETE CHIROPRACTIC SPA

Provider Business Mailing Address
First Line	:	6747 W PHILADELPHIA DR
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9490
Country	:	US
Telephone Number	:	317-340-3865
Fax Number	:

Provider Business Practice Location Address
First Line	:	1803 BROAD RIPPLE AVE
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-2339
Country	:	US
Telephone Number	:	317-537-5681
Fax Number	:

Authorized Official
Title or Position	:	CHIROPRACTOR
Name	:	TENIKA HENRY-GRAVES
Credential	:	DC
Telephone Number	:	317-536-5781

Provider Enumeration Date	:	04/14/2020
Last Update Date	:	04/14/2020

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