Provider Demographics
NPI:1073554432
Name:RASSEL FAMILYCHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:RASSEL FAMILYCHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCOUNTS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALVAREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-362-5433
Mailing Address - Street 1:1108 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LAPORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-4946
Mailing Address - Country:US
Mailing Address - Phone:219-362-5433
Mailing Address - Fax:219-362-0027
Practice Address - Street 1:1108 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LAPORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-4946
Practice Address - Country:US
Practice Address - Phone:219-362-5433
Practice Address - Fax:219-362-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN183710Medicare ID - Type Unspecified