Provider Demographics
NPI:1710506282
Name:NATURALLY COMPLETE CHIROPRACTIC SPA
Entity Type:Organization
Organization Name:NATURALLY COMPLETE CHIROPRACTIC SPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TENIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:HENRY-GRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-536-5781
Mailing Address - Street 1:6747 W PHILADELPHIA DR
Mailing Address - Street 2:
Mailing Address - City:MCCORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9490
Mailing Address - Country:US
Mailing Address - Phone:317-340-3865
Mailing Address - Fax:
Practice Address - Street 1:1803 BROAD RIPPLE AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2339
Practice Address - Country:US
Practice Address - Phone:317-537-5681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300035553Medicaid