Provider Demographics
NPI:1225190028
Name:HEALTHY CONNECTIONS HOLISTIC HEALTH CENTER PC
Entity Type:Organization
Organization Name:HEALTHY CONNECTIONS HOLISTIC HEALTH CENTER PC
Other - Org Name:THE DODGE CLINIC OF CHIROPRACTIC PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CLINTON
Authorized Official - Middle Name:S
Authorized Official - Last Name:DODGE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-932-3999
Mailing Address - Street 1:279 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8917
Mailing Address - Country:US
Mailing Address - Phone:812-932-3999
Mailing Address - Fax:812-932-3998
Practice Address - Street 1:279 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8917
Practice Address - Country:US
Practice Address - Phone:812-932-3999
Practice Address - Fax:812-932-3998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200814070 AMedicaid
IN233600Medicare ID - Type Unspecified