Provider Demographics
NPI:1679848329
Name:BULTEMEYER CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BULTEMEYER CHIROPRACTIC, LLC
Other - Org Name:BACK TO HEALTH CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BULTEMEYER-RIPLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-728-4194
Mailing Address - Street 1:1015 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2164
Mailing Address - Country:US
Mailing Address - Phone:260-728-4194
Mailing Address - Fax:260-728-4195
Practice Address - Street 1:1015 S 11TH ST
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2164
Practice Address - Country:US
Practice Address - Phone:260-728-4194
Practice Address - Fax:260-728-4195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002260A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty