Provider Demographics
NPI:1477921401
Name:ACUPUNCTURE PAIN RELIEF CENTERS OF INDIANA, LLC
Entity type:Organization
Organization Name:ACUPUNCTURE PAIN RELIEF CENTERS OF INDIANA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:317-478-7216
Mailing Address - Street 1:918 FRY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-1819
Mailing Address - Country:US
Mailing Address - Phone:317-478-7216
Mailing Address - Fax:866-371-1656
Practice Address - Street 1:918 FRY RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-1819
Practice Address - Country:US
Practice Address - Phone:317-478-7216
Practice Address - Fax:866-371-1656
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-08
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN84000114A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty