Provider Demographics
NPI:1841762663
Name:ANGOLA FAMILY CHIROPRACTIC & INTEGRATIVE HEALING CENTER, LLC
Entity Type:Organization
Organization Name:ANGOLA FAMILY CHIROPRACTIC & INTEGRATIVE HEALING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:FIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-667-8269
Mailing Address - Street 1:114 E MAUMEE ST STE 101
Mailing Address - Street 2:
Mailing Address - City:ANGOLA
Mailing Address - State:IN
Mailing Address - Zip Code:46703-1978
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:114 E MAUMEE ST STE 101
Practice Address - Street 2:
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-1978
Practice Address - Country:US
Practice Address - Phone:260-667-8269
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1942724836OtherNPI