Provider Demographics
NPI:1881098655
Name:ALLISONVILLE INTEGRATIVE HEALTH
Entity type:Organization
Organization Name:ALLISONVILLE INTEGRATIVE HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:FREY
Authorized Official - Suffix:
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:219-308-6577
Mailing Address - Street 1:11521 FISHERS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-1860
Mailing Address - Country:US
Mailing Address - Phone:317-842-1188
Mailing Address - Fax:317-842-8522
Practice Address - Street 1:11521 FISHERS DR
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-1860
Practice Address - Country:US
Practice Address - Phone:317-842-1188
Practice Address - Fax:317-842-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002786A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty