Provider Demographics
NPI:1801907092
Name:INDRISO, NANCY LYN (DC)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:LYN
Last Name:INDRISO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 BILTMORE AVENUE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803
Mailing Address - Country:US
Mailing Address - Phone:828-236-0022
Mailing Address - Fax:828-236-0020
Practice Address - Street 1:675 BILTMORE AVENUE
Practice Address - Street 2:SUITE G
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803
Practice Address - Country:US
Practice Address - Phone:828-236-0022
Practice Address - Fax:828-236-0020
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2320111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0833XOtherBCBS NC
NC0194LOtherCNC
NC2450498Medicare ID - Type Unspecified
U62013Medicare UPIN