Provider Demographics
NPI:1063686657
Name:AMERICAN PHYSICAL MEDICINE AND REABILITATION, PC
Entity Type:Organization
Organization Name:AMERICAN PHYSICAL MEDICINE AND REABILITATION, PC
Other - Org Name:CIRCLE CITY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:LOYD
Authorized Official - Last Name:RASP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-288-5480
Mailing Address - Street 1:6612 E. 75TH STREET
Mailing Address - Street 2:SUITE 110
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250
Mailing Address - Country:US
Mailing Address - Phone:317-288-5480
Mailing Address - Fax:317-288-5481
Practice Address - Street 1:6612 E. 75TH STREET
Practice Address - Street 2:SUITE 110
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250
Practice Address - Country:US
Practice Address - Phone:317-288-5480
Practice Address - Fax:317-288-5481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU29012Medicare UPIN
IN1407092497Medicare NSC
IN201810BMedicare PIN
IN201810Medicare PIN
IN201810AMedicare PIN
INT34518Medicare UPIN