Provider Demographics
NPI:1629369319
Name:AFFORDABLE CHIROPRACTIC CLINIC LLC
Entity Type:Organization
Organization Name:AFFORDABLE CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOEL
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:CARSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-757-8166
Mailing Address - Street 1:5703 S EAST ST
Mailing Address - Street 2:SUITE H
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1989
Mailing Address - Country:US
Mailing Address - Phone:317-757-8166
Mailing Address - Fax:317-757-8422
Practice Address - Street 1:5703 S EAST ST
Practice Address - Street 2:SUITE H
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1989
Practice Address - Country:US
Practice Address - Phone:317-757-8166
Practice Address - Fax:317-757-8422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002401A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty