Provider Demographics
NPI:1730453184
Name:FIELDS CHIROPRACTIC INC
Entity type:Organization
Organization Name:FIELDS CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:FIELDS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-278-3154
Mailing Address - Street 1:2418 W 16TH ST
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:IN
Mailing Address - Zip Code:47421
Mailing Address - Country:US
Mailing Address - Phone:812-278-3154
Mailing Address - Fax:812-278-3158
Practice Address - Street 1:2418 W 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421
Practice Address - Country:US
Practice Address - Phone:812-278-3154
Practice Address - Fax:812-278-3158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001867A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200229680Medicaid