MEDICARE: BROAD RIPPLE AVE CHIROPRACTIC, P.C.

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	IN08001498	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
2	000000222754	OTHER	IN	BLUE CROSS/BLUE SHIELD

General Provider Information

NPI Number	:	1851586606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROAD RIPPLE AVE CHIROPRACTIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 20884
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-0884
Country	:	US
Telephone Number	:	317-255-4222
Fax Number	:	317-251-3801

Provider Business Practice Location Address
First Line	:	4760 E 62ND ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46220-5234
Country	:	US
Telephone Number	:	317-255-4222
Fax Number	:	317-251-3801

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. ERIC B MORRIS
Credential	:	D.C.
Telephone Number	:	317-255-4222

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	05/07/2008

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