Provider Demographics
NPI:1124233978
Name:JANSEN, NICHOLAS BERNARD (DC)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:BERNARD
Last Name:JANSEN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 BROAD RIPPLE AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-2363
Mailing Address - Country:US
Mailing Address - Phone:317-251-1800
Mailing Address - Fax:317-251-1801
Practice Address - Street 1:1810 BROAD RIPPLE AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-2363
Practice Address - Country:US
Practice Address - Phone:317-251-1800
Practice Address - Fax:317-251-1801
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2009-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002328A111N00000X
IN81000088A171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No171100000XOther Service ProvidersAcupuncturist