Provider Demographics
NPI:1184015604
Name:INJURY PROVIDER NETWORK, LLC
Entity Type:Organization
Organization Name:INJURY PROVIDER NETWORK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER LIAISON
Authorized Official - Prefix:DR
Authorized Official - First Name:DION
Authorized Official - Middle Name:
Authorized Official - Last Name:SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-344-9580
Mailing Address - Street 1:5105 S US HIGHWAY 41
Mailing Address - Street 2:PMB 179
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4790
Mailing Address - Country:US
Mailing Address - Phone:317-344-9580
Mailing Address - Fax:
Practice Address - Street 1:5105 S US HIGHWAY 41
Practice Address - Street 2:PMB 179
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4790
Practice Address - Country:US
Practice Address - Phone:317-344-9580
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty