Provider Demographics
NPI:1255532800
Name:PACELLI CHIROPRACTIC HEALTH POTENTIAL COMPLEX INC
Entity type:Organization
Organization Name:PACELLI CHIROPRACTIC HEALTH POTENTIAL COMPLEX INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLEX MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:LADD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-447-2222
Mailing Address - Street 1:40 PROFESSIONAL CT
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47905-5152
Mailing Address - Country:US
Mailing Address - Phone:765-447-2222
Mailing Address - Fax:765-447-7051
Practice Address - Street 1:40 PROFESSIONAL CT
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47905-5152
Practice Address - Country:US
Practice Address - Phone:765-447-2222
Practice Address - Fax:765-447-7051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0800547111N00000X
IN84000029A171100000X
IN08001812A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100233030AMedicaid