Provider Demographics
NPI:1568698678
Name:CHIROPRACTIC WELLNESS CENTER OF INDIANA
Entity Type:Organization
Organization Name:CHIROPRACTIC WELLNESS CENTER OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:K
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-575-9310
Mailing Address - Street 1:75 EXECUTIVE DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-2995
Mailing Address - Country:US
Mailing Address - Phone:317-575-9310
Mailing Address - Fax:317-575-8423
Practice Address - Street 1:75 EXECUTIVE DR
Practice Address - Street 2:SUITE J
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-2995
Practice Address - Country:US
Practice Address - Phone:317-575-9310
Practice Address - Fax:317-575-8423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001094111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty