Provider Demographics
NPI:1568529311
Name:HORMUTH, JANE ANN (DC)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:ANN
Last Name:HORMUTH
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S GREEN RIVER RD
Mailing Address - Street 2:STE 104
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47715-6811
Mailing Address - Country:US
Mailing Address - Phone:812-474-0704
Mailing Address - Fax:812-909-0707
Practice Address - Street 1:1111 S GREEN RIVER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47715-6811
Practice Address - Country:US
Practice Address - Phone:812-474-0704
Practice Address - Fax:812-474-0704
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200-071650AMedicaid
IN637-180OtherMEDICARE NUMBER
INU59467Medicare UPIN