Provider Demographics
NPI:1750571568
Name:MARTINSVILLE CHIROPRACTIC CARE, P.C.
Entity type:Organization
Organization Name:MARTINSVILLE CHIROPRACTIC CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-342-2208
Mailing Address - Street 1:690 E MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46151-1640
Mailing Address - Country:US
Mailing Address - Phone:765-342-2208
Mailing Address - Fax:765-342-2327
Practice Address - Street 1:690 E MORGAN ST
Practice Address - Street 2:
Practice Address - City:MARTINSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46151-1640
Practice Address - Country:US
Practice Address - Phone:765-342-2208
Practice Address - Fax:765-342-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001309111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000091286OtherANTHEM
IN100186900AMedicaid
IN100186900AMedicaid
INU22964Medicare UPIN