Provider Demographics
NPI:1972713477
Name:EATON CHIROPRACTIC INC
Entity Type:Organization
Organization Name:EATON CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-872-5151
Mailing Address - Street 1:8690 W PAHS RD
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-7666
Mailing Address - Country:US
Mailing Address - Phone:219-872-5151
Mailing Address - Fax:219-872-0177
Practice Address - Street 1:8690 W PAHS RD
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-7666
Practice Address - Country:US
Practice Address - Phone:219-872-5151
Practice Address - Fax:219-872-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002127111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000506158OtherBCBS PROVIDER NUMBER
IN1578569471OtherINDIVIDUAL PROVIDER NPI
IN08002127AOtherSTATE LICENSE NUMBER
IN200469660AMedicaid
IN08002127AOtherSTATE LICENSE NUMBER