Provider Demographics
NPI:1801420252
Name:CLEAR CHIROPRACTIC GRANGER, LLC
Entity Type:Organization
Organization Name:CLEAR CHIROPRACTIC GRANGER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OAKLAND
Authorized Official - Middle Name:L
Authorized Official - Last Name:GAERKE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-726-3404
Mailing Address - Street 1:609 N CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:IN
Mailing Address - Zip Code:47371-3011
Mailing Address - Country:US
Mailing Address - Phone:260-726-3065
Mailing Address - Fax:260-726-3406
Practice Address - Street 1:360 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:IN
Practice Address - Zip Code:46714-2041
Practice Address - Country:US
Practice Address - Phone:260-353-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-25
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty