1861832248 NPI number — NOBLESVILLE FAMILY CHIROPRACTIC, LTD

Table of content: (NPI 1861832248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861832248 NPI number — NOBLESVILLE FAMILY CHIROPRACTIC, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOBLESVILLE FAMILY CHIROPRACTIC, LTD
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:
6
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:
1861832248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
953 MAPLE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NOBLESVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46060-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-214-7218
Provider Business Mailing Address Fax Number:
317-314-7213

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
953 MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NOBLESVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46060-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-214-7218
Provider Business Practice Location Address Fax Number:
317-314-7213
Provider Enumeration Date:
06/28/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DAHLAGER
Authorized Official First Name:
BRADLEY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
630-699-6840

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  08002715A , 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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