Provider Demographics
NPI:1295002830
Name:INDIANAPOLIS FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:INDIANAPOLIS FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-788-1114
Mailing Address - Street 1:6249 S EAST ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-2091
Mailing Address - Country:US
Mailing Address - Phone:317-788-1114
Mailing Address - Fax:317-788-1156
Practice Address - Street 1:6249 S EAST ST
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-2091
Practice Address - Country:US
Practice Address - Phone:317-788-1114
Practice Address - Fax:317-788-1156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001323111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200047660Medicaid
INU28714Medicare UPIN
IN200047660Medicaid