Provider Demographics
NPI:1093261919
Name:INDIANA SPINE GROUP, PC
Entity Type:Organization
Organization Name:INDIANA SPINE GROUP, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:HARDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-228-7000
Mailing Address - Street 1:13225 N MERIDIAN ST
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5480
Mailing Address - Country:US
Mailing Address - Phone:317-228-7000
Mailing Address - Fax:317-228-2321
Practice Address - Street 1:13914 SOUTHEASTERN PKWY
Practice Address - Street 2:SUITE 201
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7127
Practice Address - Country:US
Practice Address - Phone:317-228-7000
Practice Address - Fax:317-228-2321
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDIANA SPINE GROUP, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty