Provider Demographics
NPI:1982437588
Name:AMONETT, CHRISTIAN BLAKE (DC)
Entity type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:BLAKE
Last Name:AMONETT
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 MCLAIN DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46217-4059
Mailing Address - Country:US
Mailing Address - Phone:317-850-1196
Mailing Address - Fax:
Practice Address - Street 1:6025 MADISON AVE STE D
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-4722
Practice Address - Country:US
Practice Address - Phone:317-850-1196
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08003441A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor