Provider Demographics
NPI:1548397771
Name:DETTWILER CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:DETTWILER CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:DETTWILER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-902-5802
Mailing Address - Street 1:11711 WEDGEPORT LN
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-7985
Mailing Address - Country:US
Mailing Address - Phone:317-902-5802
Mailing Address - Fax:
Practice Address - Street 1:9865 E 116TH ST
Practice Address - Street 2:SUITE 150
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-9231
Practice Address - Country:US
Practice Address - Phone:317-841-1209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002271A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty