Provider Demographics
NPI:1396925855
Name:ELWOOD CHIROPRACTIC
Entity type:Organization
Organization Name:ELWOOD CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-552-0004
Mailing Address - Street 1:PO BOX 27
Mailing Address - Street 2:
Mailing Address - City:ELWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46036-0027
Mailing Address - Country:US
Mailing Address - Phone:765-552-0004
Mailing Address - Fax:765-552-5246
Practice Address - Street 1:518 S ANDERSON ST
Practice Address - Street 2:
Practice Address - City:ELWOOD
Practice Address - State:IN
Practice Address - Zip Code:46036-2322
Practice Address - Country:US
Practice Address - Phone:765-552-0004
Practice Address - Fax:765-552-5246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001111A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN215700Medicare PIN
INT86613Medicare UPIN