Provider Demographics
NPI:1063595908
Name:SHROUT FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:SHROUT FAMILY CHIROPRACTIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHROUT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-817-9355
Mailing Address - Street 1:13170 HAZEL DELL PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033
Mailing Address - Country:US
Mailing Address - Phone:317-817-9355
Mailing Address - Fax:
Practice Address - Street 1:13170 HAZEL DELL PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46033
Practice Address - Country:US
Practice Address - Phone:317-817-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002278A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN248980Medicare PIN