Provider Demographics
NPI:1013557743
Name:DOCTOR FOOTFIXER, PC
Entity Type:Organization
Organization Name:DOCTOR FOOTFIXER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:BEST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-536-6495
Mailing Address - Street 1:4 HOLLY LN
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-4045
Mailing Address - Country:US
Mailing Address - Phone:574-536-6495
Mailing Address - Fax:
Practice Address - Street 1:400 UNION ST
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:IN
Practice Address - Zip Code:46761-2286
Practice Address - Country:US
Practice Address - Phone:260-499-0888
Practice Address - Fax:260-846-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-10
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric