Provider Demographics
NPI: | 1477845220 |
---|---|
Name: | EXCELL SPORTS CHIROPRACTIC & REHAB, LLC |
Entity Type: | Organization |
Organization Name: | EXCELL SPORTS CHIROPRACTIC & REHAB, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MARCUS |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | MCCRAY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DC |
Authorized Official - Phone: | 317-429-9031 |
Mailing Address - Street 1: | 8660 GUION RD |
Mailing Address - Street 2: | |
Mailing Address - City: | INDIANAPOLIS |
Mailing Address - State: | IN |
Mailing Address - Zip Code: | 46268-3011 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 317-429-9031 |
Mailing Address - Fax: | 317-388-8002 |
Practice Address - Street 1: | 8660 GUION RD |
Practice Address - Street 2: | |
Practice Address - City: | INDIANAPOLIS |
Practice Address - State: | IN |
Practice Address - Zip Code: | 46268-3011 |
Practice Address - Country: | US |
Practice Address - Phone: | 317-429-9031 |
Practice Address - Fax: | 317-388-8002 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2011-05-12 |
Last Update Date: | 2011-05-24 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 08002244A | 261Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center |