Provider Demographics
NPI:1598951808
Name:NILL FAMILY CHIROPRACTIC & WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:NILL FAMILY CHIROPRACTIC & WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:NILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-459-2205
Mailing Address - Street 1:4606 W JEFFERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-6826
Mailing Address - Country:US
Mailing Address - Phone:260-459-2205
Mailing Address - Fax:260-459-2209
Practice Address - Street 1:4606 W JEFFERSON BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-6826
Practice Address - Country:US
Practice Address - Phone:260-459-2205
Practice Address - Fax:260-459-2209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002139A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1649228677OtherDR. NILL INDIVIDUAL NPI#
IN000000322869OtherANTHEM BC/BS
IN000000322869OtherANTHEM BC/BS