Provider Demographics
NPI:1386765279
Name:CEREFIN CHIROPRACTIC CLINIC, INC.
Entity type:Organization
Organization Name:CEREFIN CHIROPRACTIC CLINIC, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:CEREFIN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-884-2636
Mailing Address - Street 1:7855 S EMERSON AVE
Mailing Address - Street 2:SUITE Q
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-8668
Mailing Address - Country:US
Mailing Address - Phone:317-884-2636
Mailing Address - Fax:317-884-2633
Practice Address - Street 1:7855 S EMERSON AVE
Practice Address - Street 2:SUITE Q
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8668
Practice Address - Country:US
Practice Address - Phone:317-884-2636
Practice Address - Fax:317-884-2633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2011-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001590111N00000X
IN05007356A225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200027820AMedicaid
IN200027820AMedicaid