Provider Demographics
NPI:1255455424
Name:DRUMMOND CHIROPRACTIC LLC
Entity type:Organization
Organization Name:DRUMMOND CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-336-2423
Mailing Address - Street 1:4712 E STATE ROAD 46
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-9201
Mailing Address - Country:US
Mailing Address - Phone:812-336-2423
Mailing Address - Fax:812-331-2792
Practice Address - Street 1:4712 E STATE ROAD 46
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-9201
Practice Address - Country:US
Practice Address - Phone:812-336-2423
Practice Address - Fax:812-331-2792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001974A111N00000X
IN08001975A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN184210BMedicare ID - Type Unspecified
INU87048Medicare UPIN
INU87049Medicare UPIN