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Contractor in Indianapolis, IN. Organization (NPI-2).

NPI number1083200760
StatusActive
Last updated in NPPESDec 16, 2020

Details

NPI
1083200760
Entity type
Organization (NPI-2)
Legal business name
Numbers Count
Organization subpart
No
Enumeration date
Dec 16, 2020
Certification date
Dec 16, 2020
Last updated
Dec 16, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
171W00000X Contractor––Yes
111N00000X Chiropractor––
171100000X Acupuncturist––

Practice location

8250 Bash St
Indianapolis, IN 46250-1938

Phone 317-820-7582

Mailing address

8250 Bash St
Indianapolis, IN 46250-1938

Authorized official

Latesha Newton
Owner
3178207582

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