Provider Demographics
NPI:1992025340
Name:VILLAGE CHIROPRACTIC LLC
Entity Type:Organization
Organization Name:VILLAGE CHIROPRACTIC LLC
Other - Org Name:VILLAGE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GICK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-637-9900
Mailing Address - Street 1:10536 COLDWATER RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1268
Mailing Address - Country:US
Mailing Address - Phone:260-637-9900
Mailing Address - Fax:260-637-9099
Practice Address - Street 1:10536 COLDWATER RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-1268
Practice Address - Country:US
Practice Address - Phone:260-637-9900
Practice Address - Fax:260-637-9099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002225A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INV09308Medicare UPIN