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NPI Code Detail

MEDICARE: EAST STREET SPINE & REHAB, INC.

MEDICARE: EAST STREET SPINE & REHAB, 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
1111N00000XChiropractor

General Provider Information

NPI Number : 1861709693
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST STREET SPINE & REHAB, INC.
Provider Business Mailing Address
First Line : 3786 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1241
Country : US
Telephone Number : 317-791-1511
Fax Number : 317-791-1534
Provider Business Practice Location Address
First Line : 3786 S EAST ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46227-1241
Country : US
Telephone Number : 317-791-1511
Fax Number : 317-791-1534
Authorized Official
Title or Position : CHIROPRACTOR
Name : SHANNON ROBERTS
Credential :
Telephone Number : 317-791-1511
Provider Enumeration Date : 08/31/2010
Last Update Date : 07/30/2011

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Directions to “EAST STREET SPINE & REHAB, INC. ” Practice Location

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