Provider Demographics
NPI:1750552451
Name:FALL CREEK CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FALL CREEK CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:WIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-577-1744
Mailing Address - Street 1:11780 OLIO ROAD, SUITE 200
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037
Mailing Address - Country:US
Mailing Address - Phone:317-577-1744
Mailing Address - Fax:317-577-1760
Practice Address - Street 1:11780 OLIO RD STE 200
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46037-7617
Practice Address - Country:US
Practice Address - Phone:317-577-1744
Practice Address - Fax:317-577-1760
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
08002187A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN224400Medicare PIN