Provider Demographics
NPI:1598098766
Name:BREMEN CHIROPRACTIC CENTER PC
Entity Type:Organization
Organization Name:BREMEN CHIROPRACTIC CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GARL
Authorized Official - Suffix:
Authorized Official - Credentials:DC, CCSP, LAC
Authorized Official - Phone:574-546-4111
Mailing Address - Street 1:204 E PLYMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:IN
Mailing Address - Zip Code:46506-1238
Mailing Address - Country:US
Mailing Address - Phone:574-546-4111
Mailing Address - Fax:574-546-2226
Practice Address - Street 1:204 E PLYMOUTH STREET
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:IN
Practice Address - Zip Code:46506-1238
Practice Address - Country:US
Practice Address - Phone:574-546-4111
Practice Address - Fax:574-546-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000818A111NS0005X
MI2301008007111NS0005X
IN81000035A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000090414OtherANTHEM BLUE CROSS BLUE SHIELD
000000090414OtherANTHEM BLUE CROSS BLUE SHIELD