Provider Demographics
NPI:1235487901
Name:HEALTHSOURCE CHIROPRACTIC OF WESTFIELD LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE CHIROPRACTIC OF WESTFIELD LLC
Other - Org Name:STACEY YOUNG
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-757-9442
Mailing Address - Street 1:785 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46074-9440
Mailing Address - Country:US
Mailing Address - Phone:317-757-9442
Mailing Address - Fax:318-804-8300
Practice Address - Street 1:785 E MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:IN
Practice Address - Zip Code:46074-9440
Practice Address - Country:US
Practice Address - Phone:317-757-9442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-28
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002515A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002515AOtherCHIROPRACTIC LICENSE