Provider Demographics
NPI:1215198676
Name:DRUMMOND CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:DRUMMOND CHIROPRACTIC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAMS
Authorized Official - Middle Name:DALLAS
Authorized Official - Last Name:DRUMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-876-5095
Mailing Address - Street 1:202 E TEMPERANCE ST
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-1836
Mailing Address - Country:US
Mailing Address - Phone:812-876-5095
Mailing Address - Fax:812-876-5094
Practice Address - Street 1:202 E TEMPERANCE ST
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-1836
Practice Address - Country:US
Practice Address - Phone:812-876-5095
Practice Address - Fax:812-876-5094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-18
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ08001975A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INU87048Medicare UPIN