Provider Demographics
NPI:1841438884
Name:DRACH CHIROPRACTIC, L.L.C.
Entity type:Organization
Organization Name:DRACH CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:W
Authorized Official - Last Name:BORUFF
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-946-7764
Mailing Address - Street 1:P.O. BOX 193
Mailing Address - Street 2:
Mailing Address - City:WINAMAC
Mailing Address - State:IN
Mailing Address - Zip Code:46996-0193
Mailing Address - Country:US
Mailing Address - Phone:574-946-7764
Mailing Address - Fax:574-946-7769
Practice Address - Street 1:708 N PLYMOUTH RD
Practice Address - Street 2:
Practice Address - City:WINAMAC
Practice Address - State:IN
Practice Address - Zip Code:46996-7641
Practice Address - Country:US
Practice Address - Phone:574-946-7764
Practice Address - Fax:574-946-7769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-29
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IN08002203A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200520760Medicaid
IN200941340Medicaid
260170Medicare PIN
INU83788Medicare UPIN
IN229390Medicare PIN