Provider Demographics
NPI:1528192663
Name:JACKSON COUNTY CHIROPRACTIC CENTER, P.S.C.
Entity Type:Organization
Organization Name:JACKSON COUNTY CHIROPRACTIC CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRAWCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-524-2273
Mailing Address - Street 1:1260 E TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3540
Mailing Address - Country:US
Mailing Address - Phone:812-524-2273
Mailing Address - Fax:812-522-9852
Practice Address - Street 1:1260 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3540
Practice Address - Country:US
Practice Address - Phone:812-524-2273
Practice Address - Fax:812-522-9852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001209A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INT54479Medicare UPIN
IN381770Medicare PIN