Provider Demographics
NPI:1649499906
Name:SHADELAND CHIROPRACTIC
Entity type:Organization
Organization Name:SHADELAND CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:VIC
Authorized Official - Last Name:BARNHART
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-352-1516
Mailing Address - Street 1:PO BOX 19839
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-0839
Mailing Address - Country:US
Mailing Address - Phone:317-352-1516
Mailing Address - Fax:317-356-5178
Practice Address - Street 1:1841 N SHADELAND AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-2735
Practice Address - Country:US
Practice Address - Phone:317-352-1516
Practice Address - Fax:317-356-5178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001268A261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN264300Medicare ID - Type Unspecified
INU20698Medicare UPIN