Provider Demographics
NPI:1679755490
Name:WEST MORRIS STREET CHIROPRACTIC CLINIC INC
Entity Type:Organization
Organization Name:WEST MORRIS STREET CHIROPRACTIC CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:W
Authorized Official - Last Name:FOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-638-2822
Mailing Address - Street 1:1759 W MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46221-1641
Mailing Address - Country:US
Mailing Address - Phone:317-638-2822
Mailing Address - Fax:317-638-2824
Practice Address - Street 1:1759 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46221-1641
Practice Address - Country:US
Practice Address - Phone:317-638-2822
Practice Address - Fax:317-638-2824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000680A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN845530Medicare PIN