Organization
DIVINE CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JORDAN DIVINE (MANAGER)
(812) 295-5600
Entity
Organization
Contact information
Practice address
404 NORTH JOHN F KENNEDY AVENUE, LOOGOOTEE, IN 47553
(812) 295-5600
Mailing address
404 NORTH JOHN F KENNEDY AVENUE, LOOGOOTEE, IN 47553
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
08002579A
IN
Other
Enumeration date
07/19/2011
Last updated
07/19/2011
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