Provider Demographics
NPI:1811569742
Name:NEW WAVE CHIROPRACTIC LLC
Entity type:Organization
Organization Name:NEW WAVE CHIROPRACTIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MACKENZIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RYCZEK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-883-9420
Mailing Address - Street 1:997 E COUNTY LINE RD STE U
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1076
Mailing Address - Country:US
Mailing Address - Phone:317-883-9420
Mailing Address - Fax:317-883-9920
Practice Address - Street 1:997 E COUNTY LINE RD STE U
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1076
Practice Address - Country:US
Practice Address - Phone:317-883-9420
Practice Address - Fax:317-883-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-12
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty