Provider Demographics
NPI:1801478557
Name:FOUNDATIONS CHIROPRACTIC LLC
Entity type:Organization
Organization Name:FOUNDATIONS CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENNES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:920-850-4814
Mailing Address - Street 1:7110 WESTHAVEN CIR APT 204
Mailing Address - Street 2:
Mailing Address - City:ZIONSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46077-7745
Mailing Address - Country:US
Mailing Address - Phone:920-850-4814
Mailing Address - Fax:
Practice Address - Street 1:7625 W STONEGATE DR STE 100
Practice Address - Street 2:
Practice Address - City:ZIONSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46077-8595
Practice Address - Country:US
Practice Address - Phone:920-850-8148
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty