Provider Demographics
NPI:1508055252
Name:SELL CHIROPRACTIC PC
Entity Type:Organization
Organization Name:SELL CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SELL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-356-6666
Mailing Address - Street 1:1143 1ST ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:46750-2313
Mailing Address - Country:US
Mailing Address - Phone:260-356-6666
Mailing Address - Fax:260-356-6449
Practice Address - Street 1:1143 1ST ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:IN
Practice Address - Zip Code:46750-2313
Practice Address - Country:US
Practice Address - Phone:260-356-6666
Practice Address - Fax:260-356-6449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001050111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN403030Medicare PIN