NPIMap

Organization Active NPI

Paradis Isles Wellness, LLC

  • Chiropractor
  • Indianapolis, IN
National Provider Identifier
1710132758
Registry record updated Nov 18, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
Legal business name
PARADIS ISLES WELLNESS, LLC
Doing business as
ProHealth Chiropractic
Practice address
2812 Coopersmith CT
Indianapolis, IN 46268-5019
Phone
(317) 536-5330
Fax
(317) 219-3083
NPI assigned
Nov 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 18, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Jay Wesley Bogan
Title
Owner
Phone
(317) 536-5330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193400000X SINGLE SPECIALTY GROUP 111N00000X Primary

Addresses

Primary practice location

2812 Coopersmith CT
Indianapolis, IN 46268-5019

Mailing address

2812 Coopersmith CT
Indianapolis, IN 46268-5019
Phone (317) 536-5330

Other identifiers 1

IdentifierTypeStateIssuer
8919475900OtherINDRIVER LICENSE

Other names 1

  • ProHealth Chiropractic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1226966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1226966400000",
    "number": "1710132758",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2812 COOPERSMITH CT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462685019",
            "telephone_number": "317-536-5330",
            "fax_number": "317-219-3083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2812 COOPERSMITH CT",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462685019",
            "telephone_number": "317-536-5330",
            "fax_number": "317-219-3083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARADIS ISLES WELLNESS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-11-18",
        "last_updated": "2008-11-18",
        "status": "A",
        "authorized_official_last_name": "BOGAN",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "WESLEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "317-536-5330",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVER LICENSE",
            "identifier": "8919475900",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ProHealth Chiropractic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.