Provider Demographics
NPI:1730359308
Name:MISKELLY CHIROPRACTIC CENTER P C
Entity type:Organization
Organization Name:MISKELLY CHIROPRACTIC CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MISKELLY
Authorized Official - Suffix:
Authorized Official - Credentials:D C
Authorized Official - Phone:260-747-1596
Mailing Address - Street 1:2811 LOWER HUNTINGTON RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46809-2616
Mailing Address - Country:US
Mailing Address - Phone:260-747-1596
Mailing Address - Fax:260-747-1597
Practice Address - Street 1:2811 LOWER HUNTINGTON RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46809-2616
Practice Address - Country:US
Practice Address - Phone:260-747-1596
Practice Address - Fax:260-747-1597
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08000497A261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000175462OtherBC/BS
IN048870OtherMEDICARE
INU19818Medicare UPIN