Provider Demographics
NPI:1962633248
Name:THE COLUMBUS CLINIC OF CHIROPRACTIC P.C.
Entity Type:Organization
Organization Name:THE COLUMBUS CLINIC OF CHIROPRACTIC P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-342-0600
Mailing Address - Street 1:4010 W GOELLER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-8892
Mailing Address - Country:US
Mailing Address - Phone:812-342-0600
Mailing Address - Fax:812-342-0601
Practice Address - Street 1:4010 W GOELLER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8892
Practice Address - Country:US
Practice Address - Phone:812-342-0600
Practice Address - Fax:812-342-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-04
Last Update Date:2009-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002261A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty