MEDICARE: CHIROPRACTIC REHABILITATION AND ACUPUNCTURE, 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
2	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	:	1962105122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHIROPRACTIC REHABILITATION AND ACUPUNCTURE, INC

Provider Business Mailing Address
First Line	:	2250 WEST 86TH STREET
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1965
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2250 WEST 86TH STREET
Second Line	:	SUITE 100
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46260-1965
Country	:	US
Telephone Number	:	317-876-7826
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ROBERT WAYNE FERGUSON
Credential	:	DC
Telephone Number	:	317-876-7826

Provider Enumeration Date	:	03/24/2023
Last Update Date	:	03/24/2023

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