Provider Demographics
NPI:1962629972
Name:BEECH GROVE CHIROPRACTIC, INC P.C.
Entity Type:Organization
Organization Name:BEECH GROVE CHIROPRACTIC, INC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:317-788-0227
Mailing Address - Street 1:3850 S EMERSON AVENUE
Mailing Address - Street 2:SUITE F
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-5997
Mailing Address - Country:US
Mailing Address - Phone:317-788-0227
Mailing Address - Fax:317-788-0246
Practice Address - Street 1:3850 SOUTH EMERSON AVENUE
Practice Address - Street 2:SUITE F
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203-5997
Practice Address - Country:US
Practice Address - Phone:317-788-0227
Practice Address - Fax:317-788-0246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001592111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200028020AMedicaid