Provider Demographics
NPI:1134496417
Name:CLINTON COUNTY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:CLINTON COUNTY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RON
Authorized Official - Middle Name:D
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-654-4416
Mailing Address - Street 1:2003 E WABASH ST
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IN
Mailing Address - Zip Code:46041-2754
Mailing Address - Country:US
Mailing Address - Phone:765-654-4416
Mailing Address - Fax:765-659-1178
Practice Address - Street 1:2003 E WABASH ST
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IN
Practice Address - Zip Code:46041-2754
Practice Address - Country:US
Practice Address - Phone:765-654-4416
Practice Address - Fax:765-659-1178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty