Provider Demographics
NPI:1669691770
Name:ADVANTAGE CHIROPRACTIC
Entity type:Organization
Organization Name:ADVANTAGE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:MENENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-246-2225
Mailing Address - Street 1:1086 COPPERFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47122-9076
Mailing Address - Country:US
Mailing Address - Phone:812-951-1086
Mailing Address - Fax:812-951-3626
Practice Address - Street 1:1086 COPPERFIELD DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:IN
Practice Address - Zip Code:47122-9076
Practice Address - Country:US
Practice Address - Phone:812-951-1086
Practice Address - Fax:812-951-3626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000501113OtherANTHEM
IN200414900AMedicaid
IN232680Medicare PIN