MEDICARE: ACUPUNCTURE AND CHIROPRACTIC CENTER OF INDIANAPOLIS 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	171100000X	Acupuncturist	81000010A	IN
2	111N00000X	Chiropractor	08001826A	IN

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	:	1790744761
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACUPUNCTURE AND CHIROPRACTIC CENTER OF INDIANAPOLIS INC

Provider Business Mailing Address
First Line	:	4303 S EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1514
Country	:	US
Telephone Number	:	317-781-9636
Fax Number	:	317-781-9635

Provider Business Practice Location Address
First Line	:	4303 S EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46227-1514
Country	:	US
Telephone Number	:	317-781-9636
Fax Number	:	317-781-9635

Authorized Official
Title or Position	:	PRESIDENT
Name	:	LAWRENCE H PAYTON
Credential	:	DC
Telephone Number	:	317-781-9636

Provider Enumeration Date	:	03/20/2006
Last Update Date	:	01/06/2011

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