Provider Demographics
NPI:1023051885
Name:HOOSIER CHIROPRACTOR INC.
Entity type:Organization
Organization Name:HOOSIER CHIROPRACTOR INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:FERRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-585-9111
Mailing Address - Street 1:12816 FORD DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-2894
Mailing Address - Country:US
Mailing Address - Phone:317-585-9111
Mailing Address - Fax:317-585-9115
Practice Address - Street 1:12816 FORD DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-2894
Practice Address - Country:US
Practice Address - Phone:317-585-9111
Practice Address - Fax:317-585-9115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
220550Medicare ID - Type Unspecified