Provider Demographics
NPI:1972676435
Name:FRANKLIN COUNTY CHIROPRACTIC CLINIC, INC
Entity Type:Organization
Organization Name:FRANKLIN COUNTY CHIROPRACTIC CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:BUKOFCHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-647-5332
Mailing Address - Street 1:1235 FRANKLIN AVE
Mailing Address - Street 2:P O BOX 387
Mailing Address - City:BROOKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47012-1037
Mailing Address - Country:US
Mailing Address - Phone:765-647-5332
Mailing Address - Fax:765-647-5332
Practice Address - Street 1:1235 FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:IN
Practice Address - Zip Code:47012-1037
Practice Address - Country:US
Practice Address - Phone:765-647-5332
Practice Address - Fax:765-647-5332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08007533111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100365400AMedicaid
IN100365400AMedicaid
IN260240Medicare PIN