Provider Demographics
NPI:1336267822
Name:CENTRAL CHIROPRACTIC ASSOCIATES, LLC
Entity Type:Organization
Organization Name:CENTRAL CHIROPRACTIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TED
Authorized Official - Middle Name:J
Authorized Official - Last Name:FREIDLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-883-1444
Mailing Address - Street 1:PO BOX 522
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:IN
Mailing Address - Zip Code:47167-0522
Mailing Address - Country:US
Mailing Address - Phone:812-883-1444
Mailing Address - Fax:812-883-8119
Practice Address - Street 1:1101 N JIM DAY RD
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:IN
Practice Address - Zip Code:47167-7218
Practice Address - Country:US
Practice Address - Phone:812-883-1444
Practice Address - Fax:812-883-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN219000Medicare ID - Type Unspecified
IN6092470001Medicare NSC