Provider Demographics
NPI:1689647075
Name:UNTERSEHER, NATHAN M (DC)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:M
Last Name:UNTERSEHER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1260 E TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-3540
Mailing Address - Country:US
Mailing Address - Phone:812-524-2273
Mailing Address - Fax:812-522-9852
Practice Address - Street 1:1260 E TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3540
Practice Address - Country:US
Practice Address - Phone:812-524-2273
Practice Address - Fax:812-522-9852
Is Sole Proprietor?:No
Enumeration Date:2006-02-08
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002198A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200515530Medicaid
IN381770BMedicare PIN
IN200515530Medicaid