Provider Demographics
NPI:1073771531
Name:BLOOMINGTON NEUROSPINAL CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:BLOOMINGTON NEUROSPINAL CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:C
Authorized Official - Last Name:MORROW
Authorized Official - Suffix:
Authorized Official - Credentials:DOC
Authorized Official - Phone:812-333-1206
Mailing Address - Street 1:1136 WEST 17TH STREET SUITE A
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3504
Mailing Address - Country:US
Mailing Address - Phone:812-333-1206
Mailing Address - Fax:
Practice Address - Street 1:1136 W 17TH ST STE A
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3000
Practice Address - Country:US
Practice Address - Phone:812-333-1206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000873111N00000X
IN08000875111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN544380Medicare UPIN
IN544380Medicare PIN