Provider Demographics
NPI:1629143805
Name:KENDALLVILLE CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:KENDALLVILLE CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:P
Authorized Official - Last Name:DANKLEFSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-347-1637
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:1229 N LIMA RD
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755
Mailing Address - Country:US
Mailing Address - Phone:260-347-1637
Mailing Address - Fax:260-347-0261
Practice Address - Street 1:1229 N LIMA RD
Practice Address - Street 2:
Practice Address - City:KENDALLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46755
Practice Address - Country:US
Practice Address - Phone:260-347-1637
Practice Address - Fax:260-347-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U30718Medicare UPIN
580710Medicare ID - Type Unspecified