Provider Demographics
NPI:1972608602
Name:WABASH CHIROPRACTIC CENTER INC PC
Entity Type:Organization
Organization Name:WABASH CHIROPRACTIC CENTER INC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FRISCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-563-8476
Mailing Address - Street 1:508 N WABASH ST
Mailing Address - Street 2:
Mailing Address - City:WABASH
Mailing Address - State:IN
Mailing Address - Zip Code:46992-1709
Mailing Address - Country:US
Mailing Address - Phone:260-563-8476
Mailing Address - Fax:260-563-8477
Practice Address - Street 1:508 N WABASH ST
Practice Address - Street 2:
Practice Address - City:WABASH
Practice Address - State:IN
Practice Address - Zip Code:46992-1709
Practice Address - Country:US
Practice Address - Phone:260-563-8476
Practice Address - Fax:260-563-8477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2011-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100253490AMedicaid
861250Medicare ID - Type Unspecified