1831392307 NPI number — CICERO CHIROPRACTIC INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831392307 NPI number — CICERO CHIROPRACTIC INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CICERO CHIROPRACTIC INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831392307
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
209 S PERU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CICERO
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46034-9687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-984-3578
Provider Business Mailing Address Fax Number:
317-984-3410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 S PERU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CICERO
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46034-9687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-984-3578
Provider Business Practice Location Address Fax Number:
317-984-3410
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-984-3578

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08001594 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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