Organization
ACTIVE CHIROPRACTIC CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY J KISTLER D.C. (PRESIDENT)
(317) 826-2273
Entity
Organization
Contact information
Practice address
5845 SUNNYSIDE RD, SUITE 800, INDIANAPOLIS, IN 46235-8402
(317) 826-2273
(317) 826-2673
Mailing address
5845 SUNNYSIDE RD, SUITE 800, INDIANAPOLIS, IN 46235-8402
(317) 826-2273
(317) 826-2673
Taxonomy
Speciality
Code
Description
License number
State
111NS0005X
Sports Physician Chiropractor
Primary
08001237
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000344943
BCBS
IN
01
—
P00006924
RR MEDICARE
IN
Enumeration date
01/08/2008
Last updated
02/06/2008
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