Organization
BRAINFOREST CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JASON KEITH DOMENICK D.C. (DIRECTOR)
(888) 948-1456
Entity
Organization
Contact information
Practice address
8660 GUION RD, INDIANAPOLIS, IN 46268-3011
(888) 948-1456
Mailing address
8660 GUION RD, INDIANAPOLIS, IN 46268-3011
(888) 948-1456
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002663A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201209190
—
IN
Enumeration date
10/24/2016
Last updated
10/24/2016
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