Provider Demographics
NPI:1275825069
Name:DC INTEGRATED MEDICINE CORPORATION
Entity Type:Organization
Organization Name:DC INTEGRATED MEDICINE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:812-222-0970
Mailing Address - Street 1:212 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47240-8249
Mailing Address - Country:US
Mailing Address - Phone:812-222-0970
Mailing Address - Fax:812-222-0972
Practice Address - Street 1:212 E 10TH ST
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:IN
Practice Address - Zip Code:47240-8249
Practice Address - Country:US
Practice Address - Phone:812-222-0970
Practice Address - Fax:812-222-0972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-11
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02003584A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INM100045876Medicare UPIN