Provider Demographics
NPI:1760525067
Name:LAGRANGE WELLNESS CHIROPRACTOC
Entity Type:Organization
Organization Name:LAGRANGE WELLNESS CHIROPRACTOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:CONDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-330-0909
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-0457
Mailing Address - Country:US
Mailing Address - Phone:812-330-0909
Mailing Address - Fax:812-330-0099
Practice Address - Street 1:2005 S HIGHWAY 53 STE C
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-9109
Practice Address - Country:US
Practice Address - Phone:812-330-0909
Practice Address - Fax:812-330-0099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty