Provider Demographics
NPI:1568629285
Name:HORMUTH CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:HORMUTH CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT / PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HORMUTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-474-0704
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:812-474-0704
Practice Address - Street 1:1111 S GREEN RIVER RD
Practice Address - Street 2:STE 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001611111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty