Provider Demographics
NPI:1710211792
Name:CHIRO 1ST PC OF INDIANA
Entity Type:Organization
Organization Name:CHIRO 1ST PC OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS - OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGALANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-898-5800
Mailing Address - Street 1:11020 E 10TH ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3710
Mailing Address - Country:US
Mailing Address - Phone:317-898-5800
Mailing Address - Fax:317-898-5883
Practice Address - Street 1:11020 E 10TH ST UNIT B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3710
Practice Address - Country:US
Practice Address - Phone:317-898-5800
Practice Address - Fax:317-898-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01017401A332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1568510501OtherNPI - DR. SANGALANG
IN1063611325OtherGROUP NPI
IN1952320772OtherNPI - DR. BREWER
IN1952320772OtherNPI - DR. BREWER