Provider Demographics
NPI:1760527709
Name:CHIROPRACTIC HEALTH SERVICES, P.C.
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH SERVICES, P.C.
Other - Org Name:ALTER CHIROPRACTIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ALTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-485-3146
Mailing Address - Street 1:4222 HOBSON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-8648
Mailing Address - Country:US
Mailing Address - Phone:260-485-3146
Mailing Address - Fax:260-486-5278
Practice Address - Street 1:4222 HOBSON CT
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-8648
Practice Address - Country:US
Practice Address - Phone:260-485-3146
Practice Address - Fax:260-486-5278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000142A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN230760OtherMEDICARE ID
IN100081870BMedicaid
IN100081870BMedicaid