Provider Demographics
NPI:1427194208
Name:CRAWFORDSVILLE CHIROTEAM, INC
Entity Type:Organization
Organization Name:CRAWFORDSVILLE CHIROTEAM, INC
Other - Org Name:CRAWFORDSVILLE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRADBURY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-362-1500
Mailing Address - Street 1:502 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47933-1817
Mailing Address - Country:US
Mailing Address - Phone:765-362-1500
Mailing Address - Fax:765-361-8919
Practice Address - Street 1:502 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CRAWFORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47933-1817
Practice Address - Country:US
Practice Address - Phone:765-362-1500
Practice Address - Fax:765-361-8919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001892A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000369272OtherANTHEM BLUE CROSS SHIELD
IN220010Medicare ID - Type Unspecified