Provider Demographics
NPI:1699909523
Name:LAPORTE CHIROPRACTIC CLINIC INC.
Entity type:Organization
Organization Name:LAPORTE CHIROPRACTIC CLINIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:N
Authorized Official - Last Name:STULC
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-325-0441
Mailing Address - Street 1:602 I ST
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5530
Mailing Address - Country:US
Mailing Address - Phone:219-325-0441
Mailing Address - Fax:219-325-0549
Practice Address - Street 1:602 I ST
Practice Address - Street 2:
Practice Address - City:LA PORTE
Practice Address - State:IN
Practice Address - Zip Code:46350-5530
Practice Address - Country:US
Practice Address - Phone:219-325-0441
Practice Address - Fax:219-325-0549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-06
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001662A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200113870AMedicaid
INU64544Medicare UPIN
IN134840Medicare PIN