Provider Demographics
NPI:1528356813
Name:AVON CHIROPRACTIC CLINIC, LLC
Entity Type:Organization
Organization Name:AVON CHIROPRACTIC CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, MSAC
Authorized Official - Phone:317-600-3070
Mailing Address - Street 1:10080 E US HIGHWAY 36 STE B
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8174
Mailing Address - Country:US
Mailing Address - Phone:317-600-3070
Mailing Address - Fax:317-600-3072
Practice Address - Street 1:10080 E US HIGHWAY 36 STE B
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8174
Practice Address - Country:US
Practice Address - Phone:317-600-3070
Practice Address - Fax:317-600-3072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-20
Last Update Date:2014-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002518A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty