Provider Demographics
NPI:1215113006
Name:MOHR, JUSTIN DAVID-GUS (DC)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DAVID-GUS
Last Name:MOHR
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 1:7390 BUSINESS CENTER DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-8662
Mailing Address - Country:US
Mailing Address - Phone:317-272-7000
Mailing Address - Fax:317-272-4302
Practice Address - Street 1:7390 BUSINESS CENTER DR
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-8662
Practice Address - Country:US
Practice Address - Phone:317-272-7000
Practice Address - Fax:317-272-4302
Is Sole Proprietor?:No
Enumeration Date:2008-01-11
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002367A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN20088440Medicaid
IN000000561996OtherANTHEM