Provider Demographics
NPI:1538594528
Name:STORM CHIROPRACTIC CLINIC LLC
Entity type:Organization
Organization Name:STORM CHIROPRACTIC CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-509-7288
Mailing Address - Street 1:622 N MADISON AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46142-4082
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:622 N MADISON AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46142-4082
Practice Address - Country:US
Practice Address - Phone:317-509-7288
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-09
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002734A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty