Provider Demographics
NPI:1427022946
Name:CLEAR CHIROPRACTIC INDIANA, LLC
Entity Type:Organization
Organization Name:CLEAR CHIROPRACTIC INDIANA, LLC
Other - Org Name:CLEAR CHOICE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-726-3065
Mailing Address - Street 1:609 N. CHARLES ST.
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-3011
Mailing Address - Country:US
Mailing Address - Phone:260-726-3404
Mailing Address - Fax:260-726-3406
Practice Address - Street 1:609 N. CHARLES ST.
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:IN
Practice Address - Zip Code:47371-3011
Practice Address - Country:US
Practice Address - Phone:260-726-3404
Practice Address - Fax:260-726-3406
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-13
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200936780AMedicaid
IN200936780AMedicaid