Provider Demographics
NPI:1851596175
Name:CHIROPRACTIC CONCEPTS INC
Entity Type:Organization
Organization Name:CHIROPRACTIC CONCEPTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:TOOLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-548-4404
Mailing Address - Street 1:1052 MARSH ST STE E
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-6272
Mailing Address - Country:US
Mailing Address - Phone:219-548-4404
Mailing Address - Fax:219-548-4405
Practice Address - Street 1:1052 MARSH ST STE E
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-6272
Practice Address - Country:US
Practice Address - Phone:219-548-4404
Practice Address - Fax:219-548-4405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001761A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200150Medicare ID - Type UnspecifiedFACILITY LEGACY NUMBER
INU70456Medicare UPIN
IN200150AMedicare ID - Type UnspecifiedPROVIDER LEGACY NUMBER