Organization
PARADIS ISLES WELLNESS, LLC
Active
Other names
ProHealth Chiropractic
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAY WESLEY BOGAN (OWNER)
(317) 536-5330
Entity
Organization
Contact information
Practice address
2812 COOPERSMITH CT, INDIANAPOLIS, IN 46268-5019
(317) 536-5330
(317) 219-3083
Mailing address
2812 COOPERSMITH CT, INDIANAPOLIS, IN 46268-5019
(317) 536-5330
(317) 219-3083
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
8919475900
DRIVER LICENSE
IN
Enumeration date
11/18/2008
Last updated
11/18/2008
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