Provider Demographics
NPI:1316088578
Name:HARRISON COUNTY CHIROPRACTIC PC
Entity type:Organization
Organization Name:HARRISON COUNTY CHIROPRACTIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:A
Authorized Official - Last Name:TORNATORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-734-1020
Mailing Address - Street 1:PO BOX 221273
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40252-1273
Mailing Address - Country:US
Mailing Address - Phone:812-734-1020
Mailing Address - Fax:812-225-5145
Practice Address - Street 1:2230 EDSEL LANE SUITE 1
Practice Address - Street 2:
Practice Address - City:CORYDON
Practice Address - State:IN
Practice Address - Zip Code:47112-2136
Practice Address - Country:US
Practice Address - Phone:812-734-1020
Practice Address - Fax:812-225-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002154A111N00000X
IN08001935A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200085010AMedicaid
IN00000029350OtherANTHEM BLUE CROSS BLUE SH
DB4661OtherRAILROAD MEDICARE
IN200085010AMedicaid