Provider Demographics
NPI:1659687705
Name:COUGHLIN CHIROPRACTIC INC
Entity Type:Organization
Organization Name:COUGHLIN CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:M
Authorized Official - Last Name:COUGHLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-495-9882
Mailing Address - Street 1:5680 CAITO DR STE 105
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46226-1367
Mailing Address - Country:US
Mailing Address - Phone:317-495-9882
Mailing Address - Fax:317-495-9883
Practice Address - Street 1:5680 CAITO DR STE 105
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46226-1367
Practice Address - Country:US
Practice Address - Phone:317-495-9882
Practice Address - Fax:317-495-9883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-27
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002463A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN08002463AOtherLICENSE #
IN1972837219OtherINDIVIDUAL NPI