Provider Demographics
NPI:1649270992
Name:RIVERTOWN CHIROPRACTIC, LLC.
Entity type:Organization
Organization Name:RIVERTOWN CHIROPRACTIC, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:JACOB
Authorized Official - Last Name:WALBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-273-4325
Mailing Address - Street 1:401 E 2ND ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-3513
Mailing Address - Country:US
Mailing Address - Phone:812-273-4325
Mailing Address - Fax:812-273-9275
Practice Address - Street 1:401 E 2ND ST
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-3513
Practice Address - Country:US
Practice Address - Phone:812-273-4325
Practice Address - Fax:812-273-9275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001724A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
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P00094455OtherRAILROAD MEDICARE
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000000321777OtherANTHEM BLUE CROSS/SHIELD
P00094455OtherRAILROAD MEDICARE