Provider Demographics
NPI:1124120373
Name:CHIROPRACTIC RESOURCE CENTER
Entity type:Organization
Organization Name:CHIROPRACTIC RESOURCE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOSLER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:260-493-6565
Mailing Address - Street 1:108 LANDIN RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:IN
Mailing Address - Zip Code:46774-1168
Mailing Address - Country:US
Mailing Address - Phone:260-493-6565
Mailing Address - Fax:
Practice Address - Street 1:108 LANDIN RD
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:IN
Practice Address - Zip Code:46774-1168
Practice Address - Country:US
Practice Address - Phone:260-493-6565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100461910Medicaid
IN133490Medicare ID - Type Unspecified