Provider Demographics
NPI:1912384868
Name:DIMICK FAMILY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:DIMICK FAMILY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DC
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DIMICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-578-7544
Mailing Address - Street 1:8202 CLEARVISTA PKWY STE 9D
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1457
Mailing Address - Country:US
Mailing Address - Phone:317-578-7544
Mailing Address - Fax:317-578-9604
Practice Address - Street 1:8202 CLEARVISTA PKWY STE 9D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1457
Practice Address - Country:US
Practice Address - Phone:317-578-7544
Practice Address - Fax:317-578-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002058A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty