Provider Demographics
NPI:1205894912
Name:INDIANA CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:INDIANA CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHARBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:724-465-5608
Mailing Address - Street 1:272 RUSTIC LODGE ROAD
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1595
Mailing Address - Country:US
Mailing Address - Phone:724-465-5608
Mailing Address - Fax:724-465-2168
Practice Address - Street 1:272 RUSTIC LODGE ROAD
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1595
Practice Address - Country:US
Practice Address - Phone:724-465-5608
Practice Address - Fax:724-465-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC002862L111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016371890002Medicaid
PA0016371890002Medicaid