Provider Demographics
NPI:1184929010
Name:DUPONT CHIROPRACTIC RESOURCE CENTER INC.
Entity type:Organization
Organization Name:DUPONT CHIROPRACTIC RESOURCE CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:WEIMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-489-2266
Mailing Address - Street 1:1960 E DUPONT RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1582
Mailing Address - Country:US
Mailing Address - Phone:260-489-2266
Mailing Address - Fax:260-490-6565
Practice Address - Street 1:1960 E DUPONT RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1582
Practice Address - Country:US
Practice Address - Phone:260-489-2266
Practice Address - Fax:260-490-6565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-25
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100048776Medicaid
INT34493Medicare UPIN
INM100048776Medicare PIN