Provider Demographics
NPI:1235644733
Name:SCOTT R. MINTON CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:SCOTT R. MINTON CHIROPRACTIC, LLC
Other - Org Name:INDIANA CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-319-7630
Mailing Address - Street 1:11852 ALLISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2312
Mailing Address - Country:US
Mailing Address - Phone:317-598-5221
Mailing Address - Fax:
Practice Address - Street 1:11852 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2312
Practice Address - Country:US
Practice Address - Phone:317-598-5221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002908A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty