Provider Demographics
NPI:1851621924
Name:INDIANA CHIROPRACTIC AND REHAB LLC
Entity Type:Organization
Organization Name:INDIANA CHIROPRACTIC AND REHAB LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-340-3805
Mailing Address - Street 1:915 S MEADOWBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4233
Mailing Address - Country:US
Mailing Address - Phone:812-340-3805
Mailing Address - Fax:
Practice Address - Street 1:100 N CURRY PIKE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-2593
Practice Address - Country:US
Practice Address - Phone:812-340-3805
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty