Basic Information
| Provider Information | |||||||||
| NPI: | 1609107499 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHIROPRACTIC, ORTHOPEDIC, AND PAIN INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 OTIS BOWEN DR | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463214158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2199345300 | ||||||||
| FaxNumber: | 2199345389 | ||||||||
| Practice Location | |||||||||
| Address1: | 315 W 89TH AVE | ||||||||
| Address2: | |||||||||
| City: | MERRILLVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 464106254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2197575280 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2010 | ||||||||
| LastUpdateDate: | 01/19/2010 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | VIJAY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO AND PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 2199345300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 111NX0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | Orthopedic |
No ID Information.