Provider Demographics
NPI:1508895426
Name:ELKHART COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:ELKHART COUNTY CHIROPRACTIC
Other - Org Name:ECC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:LEWALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-534-4400
Mailing Address - Street 1:909 LINWAY DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-2431
Mailing Address - Country:US
Mailing Address - Phone:574-534-4400
Mailing Address - Fax:574-534-5855
Practice Address - Street 1:909 LINWAY DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-2431
Practice Address - Country:US
Practice Address - Phone:574-534-4400
Practice Address - Fax:574-534-5855
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100114230AMedicaid
INU35009Medicare UPIN
IN228310Medicare PIN