Provider Demographics
NPI:1356544738
Name:SHADELAND CHIROPRACTIC & WELLNESS
Entity type:Organization
Organization Name:SHADELAND CHIROPRACTIC & WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:V
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-352-1516
Mailing Address - Street 1:1841 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-2735
Mailing Address - Country:US
Mailing Address - Phone:317-352-1516
Mailing Address - Fax:
Practice Address - Street 1:1841 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2735
Practice Address - Country:US
Practice Address - Phone:317-352-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN111NR0200X, 111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No111NR0200XChiropractic ProvidersChiropractorRadiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPR28574220001OtherCIGNA
IN000000090849OtherANTHEM
INPR28574220001OtherCIGNA