Provider Demographics
NPI:1275697278
Name:SUBLUXATION CHIROPRACTIC INC
Entity Type:Organization
Organization Name:SUBLUXATION CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:K
Authorized Official - Last Name:LAWLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-623-4228
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:SUNMAN
Mailing Address - State:IN
Mailing Address - Zip Code:47041-0510
Mailing Address - Country:US
Mailing Address - Phone:812-623-4228
Mailing Address - Fax:812-623-4228
Practice Address - Street 1:8866 EAST ST. RT. #46
Practice Address - Street 2:
Practice Address - City:SUNMAN
Practice Address - State:IN
Practice Address - Zip Code:47041-0510
Practice Address - Country:US
Practice Address - Phone:812-623-4228
Practice Address - Fax:812-623-4228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001278111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN701580Medicare PIN