Provider Demographics
NPI:1902903677
Name:NARDELLA, DEXTER ALLEN (DC)
Entity Type:Individual
Prefix:DR
First Name:DEXTER
Middle Name:ALLEN
Last Name:NARDELLA
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 1:8004 HAGUE RD
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-1635
Mailing Address - Country:US
Mailing Address - Phone:317-845-9607
Mailing Address - Fax:317-913-9497
Practice Address - Street 1:8004 HAGUE RD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1635
Practice Address - Country:US
Practice Address - Phone:317-845-9607
Practice Address - Fax:317-913-9497
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000675111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000251057OtherBC/BS
IN5090276OtherAETNA
IN5090276OtherAETNA