Provider Demographics
NPI:1023138914
Name:AMIS CHIROPRACTIC, P.C.
Entity type:Organization
Organization Name:AMIS CHIROPRACTIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:AMIS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:574-825-8118
Mailing Address - Street 1:611 WAYNE ST
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9543
Mailing Address - Country:US
Mailing Address - Phone:574-825-8118
Mailing Address - Fax:574-822-1169
Practice Address - Street 1:611 WAYNE ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9543
Practice Address - Country:US
Practice Address - Phone:574-825-8118
Practice Address - Fax:574-822-1169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001879A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN181290Medicare ID - Type UnspecifiedCHIROPRACTIC OFFICE