Provider Demographics
NPI:1952524985
Name:CHIROPRACTIC PHYSICIANS P.C.
Entity type:Organization
Organization Name:CHIROPRACTIC PHYSICIANS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHEIF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:YOUNTS
Authorized Official - Suffix:
Authorized Official - Credentials:DC, LAC
Authorized Official - Phone:260-768-4061
Mailing Address - Street 1:7960 W 450 N
Mailing Address - Street 2:
Mailing Address - City:SHIPSHEWANA
Mailing Address - State:IN
Mailing Address - Zip Code:46565-9003
Mailing Address - Country:US
Mailing Address - Phone:260-768-4061
Mailing Address - Fax:260-768-4698
Practice Address - Street 1:7960 W 450 N
Practice Address - Street 2:
Practice Address - City:SHIPSHEWANA
Practice Address - State:IN
Practice Address - Zip Code:46565-9003
Practice Address - Country:US
Practice Address - Phone:260-768-4061
Practice Address - Fax:260-768-4698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001953A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1952524985Medicare PIN
IN1497741102Medicare PIN