Provider Demographics
NPI:1275529000
Name:COMMUNITY ARTS CHIROPRACTIC
Entity Type:Organization
Organization Name:COMMUNITY ARTS CHIROPRACTIC
Other - Org Name:HEALTH 1ST CHIROPRACTIC OF INDIANAPOLIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE
Authorized Official - Prefix:
Authorized Official - First Name:DECHEZ
Authorized Official - Middle Name:ALMONT
Authorized Official - Last Name:EDMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-253-1644
Mailing Address - Street 1:6326 RUCKER RD
Mailing Address - Street 2:STE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-4889
Mailing Address - Country:US
Mailing Address - Phone:317-253-1644
Mailing Address - Fax:317-536-0456
Practice Address - Street 1:6326 RUCKER RD
Practice Address - Street 2:STE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-4889
Practice Address - Country:US
Practice Address - Phone:317-253-1644
Practice Address - Fax:317-536-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002179A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20014460Medicaid
IN20014460Medicaid
U60694Medicare UPIN