Provider Demographics
NPI:1457558140
Name:MASS AVE CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:MASS AVE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D. C.
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:KIELUR
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:317-554-0748
Mailing Address - Street 1:611 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46204-1606
Mailing Address - Country:US
Mailing Address - Phone:317-554-0748
Mailing Address - Fax:317-554-0749
Practice Address - Street 1:611 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-1606
Practice Address - Country:US
Practice Address - Phone:317-554-0748
Practice Address - Fax:317-554-0749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001412A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty