Provider Demographics
NPI:1457540155
Name:OMER CHIROPRACTIC CLINIC PC
Entity Type:Organization
Organization Name:OMER CHIROPRACTIC CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:OMER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-254-0476
Mailing Address - Street 1:501 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4043
Mailing Address - Country:US
Mailing Address - Phone:812-254-0476
Mailing Address - Fax:812-254-0477
Practice Address - Street 1:501 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4043
Practice Address - Country:US
Practice Address - Phone:812-254-0476
Practice Address - Fax:812-254-0477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001596111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200025970AMedicaid
IN000000184810OtherANTHEM BLUE CROSS BLUE SH
IN200025970AMedicaid
IN254800Medicare PIN