Provider Demographics
NPI:1689907826
Name:FAULKNER CHIROPRACTIC & ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:FAULKNER CHIROPRACTIC & ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-333-3131
Mailing Address - Street 1:2205 W SUDBURY DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3813
Mailing Address - Country:US
Mailing Address - Phone:812-333-3131
Mailing Address - Fax:
Practice Address - Street 1:2205 W SUDBURY DR
Practice Address - Street 2:SUITE B
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-3813
Practice Address - Country:US
Practice Address - Phone:812-333-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-04
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001016111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000086964OtherANTHEM PIN NUMBER
IN100193700Medicaid
IN59-5030Medicare PIN