MEDICARE: INDYCHIRO, LLC

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	08001498A	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
3	08001498A	OTHER	IN	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1972813947
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INDYCHIRO, LLC

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	:	317-704-4900

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	:	317-704-4900

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

Provider Enumeration Date	:	10/08/2010
Last Update Date	:	07/15/2014

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Directions to “INDYCHIRO, LLC ” Practice Location

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