Provider Demographics
NPI:1043343171
Name:SOUTHERN INDIANA CHIROPRACTIC & REHABILITATION CENTER, P.S.C.
Entity Type:Organization
Organization Name:SOUTHERN INDIANA CHIROPRACTIC & REHABILITATION CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:DENIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-944-8000
Mailing Address - Street 1:5120 CHARLESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-9497
Mailing Address - Country:US
Mailing Address - Phone:812-944-8000
Mailing Address - Fax:812-944-8992
Practice Address - Street 1:5120 CHARLESTOWN RD
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-9497
Practice Address - Country:US
Practice Address - Phone:812-944-8000
Practice Address - Fax:812-944-8992
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001418111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN232260Medicare PIN