Provider Demographics
NPI:1063611325
Name:CHIRO 1ST PC OF INDIANA
Entity type:Organization
Organization Name:CHIRO 1ST PC OF INDIANA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SANGALANG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-898-5800
Mailing Address - Street 1:11020 E 10TH ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46229-3710
Mailing Address - Country:US
Mailing Address - Phone:317-898-5800
Mailing Address - Fax:317-898-5883
Practice Address - Street 1:11020 E 10TH ST
Practice Address - Street 2:UNIT B
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46229-3710
Practice Address - Country:US
Practice Address - Phone:317-898-5800
Practice Address - Fax:317-898-5883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-16
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
111N00000X
IN01017401A208100000X, 208D00000X
IN08001241A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1568510501OtherINDIVIDUAL NPI 1568510501
IN1952320772OtherINDIVIDUAL NPI DR. ROBERT BREWER
IN6401340001Medicare NSC
524240Medicare PIN