Provider Demographics
NPI:1295061596
Name:MCGILLEM CHIROPRACTIC & REHABILITATION
Entity type:Organization
Organization Name:MCGILLEM CHIROPRACTIC & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DEVON
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:MCGILLEM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-270-9500
Mailing Address - Street 1:855 N HIGH SCHOOL RD STE 6
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46214-5702
Mailing Address - Country:US
Mailing Address - Phone:317-270-9500
Mailing Address - Fax:317-270-9502
Practice Address - Street 1:855 N HIGH SCHOOL RD STE 6
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46214-5702
Practice Address - Country:US
Practice Address - Phone:317-270-9500
Practice Address - Fax:317-270-9502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002450A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty