Provider Demographics
NPI:1881820769
Name:CREEKSIDE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:CREEKSIDE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MERRILL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-758-4880
Mailing Address - Street 1:PO BOX 6
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:IN
Mailing Address - Zip Code:46069-0006
Mailing Address - Country:US
Mailing Address - Phone:317-758-4880
Mailing Address - Fax:
Practice Address - Street 1:306 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:IN
Practice Address - Zip Code:46069-1113
Practice Address - Country:US
Practice Address - Phone:317-758-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty