Provider Demographics
NPI:1710585955
Name:AXON MODERN HEALTH LLC
Entity Type:Organization
Organization Name:AXON MODERN HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MS
Authorized Official - Phone:219-671-4187
Mailing Address - Street 1:9783 E 116TH ST
Mailing Address - Street 2:PMB 2372
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-2822
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 MELBROOK DR
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-3019
Practice Address - Country:US
Practice Address - Phone:219-237-4568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-10
Last Update Date:2020-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty