Provider Demographics
NPI:1194867127
Name:JDN ENTERPRISES INCORPORATED
Entity Type:Organization
Organization Name:JDN ENTERPRISES INCORPORATED
Other - Org Name:NOTTGER CHIROPRACTIC AND ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-275-0500
Mailing Address - Street 1:2808 MITCHELL RD
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421-5318
Mailing Address - Country:US
Mailing Address - Phone:812-275-0500
Mailing Address - Fax:
Practice Address - Street 1:2808 MITCHELL RD
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-5318
Practice Address - Country:US
Practice Address - Phone:812-275-0500
Practice Address - Fax:812-275-3500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002094A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1295710424OtherRENDERING PROVIDER ID