Provider Demographics
NPI:1366659633
Name:FRANKLIN STREET CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:FRANKLIN STREET CHIROPRACTIC L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:IGNACIO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-425-5686
Mailing Address - Street 1:2222 W FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-5117
Mailing Address - Country:US
Mailing Address - Phone:812-425-5686
Mailing Address - Fax:812-422-0429
Practice Address - Street 1:2732 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47712-6754
Practice Address - Country:US
Practice Address - Phone:812-425-5686
Practice Address - Fax:812-422-0429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001689A111N00000X
IN08001671111N00000X
IN08002410A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200129900AMedicaid
IN200129900AMedicaid