Provider Demographics
NPI:1568645323
Name:KAURICH CHIROPRACTIC, PC
Entity Type:Organization
Organization Name:KAURICH CHIROPRACTIC, PC
Other - Org Name:KAURICH CHIROPRACTIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:KAURICH
Authorized Official - Suffix:
Authorized Official - Credentials:DC,
Authorized Official - Phone:574-282-2828
Mailing Address - Street 1:3511 LINCOLNWAY W
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-1411
Mailing Address - Country:US
Mailing Address - Phone:574-282-2828
Mailing Address - Fax:574-282-1802
Practice Address - Street 1:3511 LINCOLNWAY W
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-1411
Practice Address - Country:US
Practice Address - Phone:574-282-2828
Practice Address - Fax:574-282-1802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2014-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001607A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200032070Medicaid
IN232050AMedicare PIN