Provider Demographics
NPI:1841489887
Name:CHIDEBELU-EZE, CHUKWUEMEKA KELECHI (DC)
Entity type:Individual
Prefix:DR
First Name:CHUKWUEMEKA
Middle Name:KELECHI
Last Name:CHIDEBELU-EZE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 AUBURN HILL DR
Mailing Address - Street 2:G
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46224-7137
Mailing Address - Country:US
Mailing Address - Phone:773-885-5031
Mailing Address - Fax:
Practice Address - Street 1:819 AUBURN HILL DR
Practice Address - Street 2:G
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46224-7137
Practice Address - Country:US
Practice Address - Phone:773-885-5031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002356A111NS0005X
AL2201111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NX0800XChiropractic ProvidersChiropractorOrthopedic