Provider Demographics
NPI:1518136936
Name:CHIROPRACTIC NEUROLOGY CENTER OF INDIANAPOLIS, PC
Entity Type:Organization
Organization Name:CHIROPRACTIC NEUROLOGY CENTER OF INDIANAPOLIS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:R
Authorized Official - Last Name:RALSTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-848-6000
Mailing Address - Street 1:9302 N MERIDIAN ST
Mailing Address - Street 2:STE 299
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-1873
Mailing Address - Country:US
Mailing Address - Phone:317-848-6000
Mailing Address - Fax:317-848-6011
Practice Address - Street 1:9302 N MERIDIAN ST
Practice Address - Street 2:STE 299
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1873
Practice Address - Country:US
Practice Address - Phone:317-848-6000
Practice Address - Fax:317-848-6011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-29
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NN0400XChiropractic ProvidersChiropractorNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200363370AMedicaid
000000198956OtherBLUE CROSS/BLUE SHIELD
IN181110Medicare PIN
IN200363370AMedicaid