Provider Demographics
NPI:1760094692
Name:GARCIA PORTALATIN, KARLA N (DC)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:N
Last Name:GARCIA PORTALATIN
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-5725
Mailing Address - Country:US
Mailing Address - Phone:812-373-3376
Mailing Address - Fax:812-373-7977
Practice Address - Street 1:1405 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-5725
Practice Address - Country:US
Practice Address - Phone:812-373-3376
Practice Address - Fax:812-373-7977
Is Sole Proprietor?:No
Enumeration Date:2020-08-21
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003180A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor