Provider Demographics
NPI:1811337322
Name:CHIROPRACTIC SOLUTIONS OF WEST LAFAYETTE, LLC
Entity type:Organization
Organization Name:CHIROPRACTIC SOLUTIONS OF WEST LAFAYETTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WEIDA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:765-838-3489
Mailing Address - Street 1:3005 GREENBUSH ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47904-2435
Mailing Address - Country:US
Mailing Address - Phone:765-838-3489
Mailing Address - Fax:765-838-3954
Practice Address - Street 1:3005 GREENBUSH ST
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47904-2435
Practice Address - Country:US
Practice Address - Phone:765-838-3489
Practice Address - Fax:765-838-3954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-28
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002587A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty