Provider Demographics
NPI:1700332749
Name:RASSEL FAMILY CHIROPRACTIC CENTER
Entity Type:Organization
Organization Name:RASSEL FAMILY CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:RASSEL
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-362-5433
Mailing Address - Street 1:1108 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-4946
Mailing Address - Country:US
Mailing Address - Phone:219-362-5433
Mailing Address - Fax:
Practice Address - Street 1:1108 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-4946
Practice Address - Country:US
Practice Address - Phone:219-362-5433
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-30
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002005A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200349600AMedicaid
IN200349600AMedicaid