Provider Demographics
NPI:1790744761
Name:ACUPUNCTURE AND CHIROPRACTIC CENTER OF INDIANAPOLIS INC
Entity Type:Organization
Organization Name:ACUPUNCTURE AND CHIROPRACTIC CENTER OF INDIANAPOLIS INC
Other - Org Name:LAWRENCE PAYTON CHIROPRACTIC & ACUPUNCTURE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:PAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-781-9636
Mailing Address - Street 1:4303 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-1514
Mailing Address - Country:US
Mailing Address - Phone:317-781-9636
Mailing Address - Fax:317-781-9635
Practice Address - Street 1:4303 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-1514
Practice Address - Country:US
Practice Address - Phone:317-781-9636
Practice Address - Fax:317-781-9635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001826A111N00000X
IN81000010A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200216490BMedicaid
IN201600Medicare PIN