Provider Demographics
NPI:1427179159
Name:UPTOWN CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:UPTOWN CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:ERICH
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-269-7726
Mailing Address - Street 1:827 S UNION ST
Mailing Address - Street 2:STE 210
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-4703
Mailing Address - Country:US
Mailing Address - Phone:574-269-7726
Mailing Address - Fax:574-269-7728
Practice Address - Street 1:827 S UNION ST
Practice Address - Street 2:STE 210
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46580-4703
Practice Address - Country:US
Practice Address - Phone:574-269-7726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001580A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200358820AMedicaid
INU452310Medicare UPIN