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Middlebury Chiropractic Clinic LLC

Organization Active NPI Chiropractor · Middlebury, IN

NPI 1104046663 · NPPES record last updated Jul 3, 2008

Key facts

NPI
1104046663
Entity type
Organization (NPI type 2)
Primary specialty
Chiropractor 111N00000X
License
08000569A (IN)
Legal business name
MIDDLEBURY CHIROPRACTIC CLINIC LLC
Practice address
516 S Main St
Middlebury, IN 46540-9701
Phone
(574) 825-9124
Fax
(574) 825-1127
NPI assigned
Apr 26, 2007
Organization subpart
No

Authorized official

Name
Dr. Norman Miller, D.C.
Title
President
Phone
(574) 825-9124

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

National Provider Directory

Locations

516 S Main St
Middlebury, IN 46540
Phone (219) 825-9124

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor
Group: 193400000X SINGLE SPECIALTY GROUP		 111N00000X 08000569A IN Yes

Addresses

Primary practice location

516 S Main St
Middlebury, IN 46540-9701

Mailing address

516 S Main St
Middlebury, IN 46540-9701
Phone (574) 825-9124

Other identifiers

IdentifierTypeStateIssuer
000000518469OtherINANTHEM

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 3, 2008.

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1104046663",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 S MAIN ST",
            "city": "MIDDLEBURY",
            "state": "IN",
            "postal_code": "465409701",
            "telephone_number": "574-825-9124",
            "fax_number": "574-825-1127"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "516 S MAIN ST",
            "city": "MIDDLEBURY",
            "state": "IN",
            "postal_code": "465409701",
            "telephone_number": "574-825-9124",
            "fax_number": "574-825-1127"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDDLEBURY CHIROPRACTIC CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-26",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "MILLER",
        "authorized_official_first_name": "NORMAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "574-825-9124",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": "IN",
            "license": "08000569A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000518469",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlebury, IN

All providers in Middlebury, IN · Chiropractor in Indiana

Sources for this page

Verify at the official NPI Registry.