Provider Demographics
NPI:1073743886
Name:INDY HEALTH WELLNESS AND REHABILITATION PC
Entity Type:Organization
Organization Name:INDY HEALTH WELLNESS AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:K
Authorized Official - Last Name:WHITEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-291-0100
Mailing Address - Street 1:5035 W 71ST ST
Mailing Address - Street 2:SUITE E
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-2186
Mailing Address - Country:US
Mailing Address - Phone:317-291-0100
Mailing Address - Fax:317-291-2501
Practice Address - Street 1:5035 W 71ST ST
Practice Address - Street 2:SUITE E
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-2186
Practice Address - Country:US
Practice Address - Phone:317-291-0100
Practice Address - Fax:317-291-2501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002165A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty