Provider Demographics
NPI:1144405465
Name:APPLIED OSTEOPATHY
Entity Type:Organization
Organization Name:APPLIED OSTEOPATHY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARREN
Authorized Official - Middle Name:P
Authorized Official - Last Name:GEBHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:317-750-6018
Mailing Address - Street 1:1075 BROAD RIPPLE AVE
Mailing Address - Street 2:BOX 252
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2034
Mailing Address - Country:US
Mailing Address - Phone:317-750-6018
Mailing Address - Fax:317-259-7668
Practice Address - Street 1:2620 KESSLER BLVD DR N
Practice Address - Street 2:STE 225
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2217
Practice Address - Country:US
Practice Address - Phone:317-750-6018
Practice Address - Fax:317-259-7668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-05
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003217A204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000552067OtherANTHEM
IN093299OtherSIHO
IN7365329OtherAETNA
IN093299OtherSIHO
IN000000552067OtherANTHEM