Provider Demographics
NPI:1821267915
Name:MCHC, PC
Entity Type:Organization
Organization Name:MCHC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-577-9558
Mailing Address - Street 1:11595 ALLISONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1863
Mailing Address - Country:US
Mailing Address - Phone:317-577-9558
Mailing Address - Fax:317-577-9559
Practice Address - Street 1:11595 ALLISONVILLE RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1863
Practice Address - Country:US
Practice Address - Phone:317-577-9558
Practice Address - Fax:317-577-9559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002072A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000298183OtherANTHEM BCBS
INU87041Medicare UPIN
IN216930AMedicare PIN
000000298183OtherANTHEM BCBS