Provider Demographics
NPI:1346526480
Name:BOONE COUNTY CHIROPRACTIC OFFICE, PC
Entity Type:Organization
Organization Name:BOONE COUNTY CHIROPRACTIC OFFICE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LINDNER
Authorized Official - Suffix:
Authorized Official - Credentials:DR OF CHIROPRACTIC
Authorized Official - Phone:765-482-1610
Mailing Address - Street 1:3920 N STATE ROAD 39
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-9389
Mailing Address - Country:US
Mailing Address - Phone:765-482-1610
Mailing Address - Fax:765-482-9659
Practice Address - Street 1:3920 N STATE ROAD 39
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-9389
Practice Address - Country:US
Practice Address - Phone:765-482-1610
Practice Address - Fax:765-482-9659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000854A302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN439600Medicare PIN