| NPI | 1184015604 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DION SNIDER Provider Liaison 317-344-9580 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111NR0400X Chiropractor, Rehabilitation |
| Additional Taxonomies | 225100000X Physical Therapist |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2015-02-06 |
| Last Update Date | 2015-02-06 |