Provider Demographics
NPI:1750575825
Name:MONROE COUNTY CHIROPRACTIC
Entity type:Organization
Organization Name:MONROE COUNTY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KARDYNALCZYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-339-4430
Mailing Address - Street 1:2974 N LAKEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47408-1081
Mailing Address - Country:US
Mailing Address - Phone:812-339-4430
Mailing Address - Fax:812-339-4476
Practice Address - Street 1:2974 N LAKEWOOD CT
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47408-1081
Practice Address - Country:US
Practice Address - Phone:812-339-4430
Practice Address - Fax:812-339-4476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001673A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000186894OtherANTHEM B/C B/S
IN200166940AMedicaid
IN000000186894OtherANTHEM B/C B/S
IN200166940AMedicaid
IN=========01OtherSAGAMORE
IN=========AOtherSIHO