Provider Demographics
NPI:1417186487
Name:DURAN BACK PAIN CHIROPRACTIC CLINIC, INC.
Entity Type:Organization
Organization Name:DURAN BACK PAIN CHIROPRACTIC CLINIC, INC.
Other - Org Name:DURAN ZORMEIER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:DURAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CSST
Authorized Official - Phone:317-392-6200
Mailing Address - Street 1:302 DURAN DR
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-1986
Mailing Address - Country:US
Mailing Address - Phone:317-392-6200
Mailing Address - Fax:317-398-7526
Practice Address - Street 1:302 DURAN DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-1986
Practice Address - Country:US
Practice Address - Phone:317-392-6200
Practice Address - Fax:317-398-7526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Multi-Specialty
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1194797308Medicaid
IN6448100001OtherDME
INU51417Medicare UPIN
IN6448100001Medicare NSC
IN6448100001OtherDME