Provider Demographics
NPI:1073980603
Name:CHIROCORE
Entity Type:Organization
Organization Name:CHIROCORE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MINNIEAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-519-3594
Mailing Address - Street 1:6072 E ANDERSON RD
Mailing Address - Street 2:
Mailing Address - City:CHURUBUSCO
Mailing Address - State:IN
Mailing Address - Zip Code:46723-9730
Mailing Address - Country:US
Mailing Address - Phone:260-519-3594
Mailing Address - Fax:
Practice Address - Street 1:6072 E ANDERSON RD
Practice Address - Street 2:
Practice Address - City:CHURUBUSCO
Practice Address - State:IN
Practice Address - Zip Code:46723-9730
Practice Address - Country:US
Practice Address - Phone:260-519-3594
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-31
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002841A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty