Provider Demographics
NPI:1790878593
Name:BROOKVILLE CHIROPRACTIC ASSOCIATES SPORTS MEDICINE,LLC
Entity Type:Organization
Organization Name:BROOKVILLE CHIROPRACTIC ASSOCIATES SPORTS MEDICINE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CALVIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-647-7300
Mailing Address - Street 1:617 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-1280
Mailing Address - Country:US
Mailing Address - Phone:765-647-7300
Mailing Address - Fax:765-647-7344
Practice Address - Street 1:617 MAIN ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-1280
Practice Address - Country:US
Practice Address - Phone:765-647-7300
Practice Address - Fax:765-647-7344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000312111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty