Provider Demographics
NPI:1245405794
Name:GOSHEN CHIROPRACTIC CENTER, PC
Entity Type:Organization
Organization Name:GOSHEN CHIROPRACTIC CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHETT
Authorized Official - Middle Name:E
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-533-2531
Mailing Address - Street 1:3014 BASHOR RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-1704
Mailing Address - Country:US
Mailing Address - Phone:574-533-2531
Mailing Address - Fax:574-533-7788
Practice Address - Street 1:3014 BASHOR RD
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-1704
Practice Address - Country:US
Practice Address - Phone:574-533-2531
Practice Address - Fax:574-533-7788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-25
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001785A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty