Provider Demographics
NPI:1780844274
Name:MERIDIAN SPINE AND JOINT REHABILITATION CENTER
Entity Type:Organization
Organization Name:MERIDIAN SPINE AND JOINT REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:C
Authorized Official - Last Name:PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:317-848-8048
Mailing Address - Street 1:8902 N MERIDIAN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46260-5306
Mailing Address - Country:US
Mailing Address - Phone:317-848-8048
Mailing Address - Fax:317-575-8807
Practice Address - Street 1:8902 N MERIDIAN ST STE 101
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-5306
Practice Address - Country:US
Practice Address - Phone:317-848-8048
Practice Address - Fax:317-575-8807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN972111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty