Provider Demographics
NPI:1194846931
Name:NORTH ANDERSON CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:NORTH ANDERSON CHIROPRACTIC, INC.
Other - Org Name:NORTH ANDERSON CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-642-1100
Mailing Address - Street 1:1817 N MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46011-2145
Mailing Address - Country:US
Mailing Address - Phone:765-642-1100
Mailing Address - Fax:765-642-2171
Practice Address - Street 1:1817 N MADISON AVE
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46011-2145
Practice Address - Country:US
Practice Address - Phone:765-642-1100
Practice Address - Fax:765-642-2171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001914A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU80175Medicare UPIN
IN150290Medicare ID - Type Unspecified