Organization
HOOSIER SPORTS & CHIROPRACTIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JENNIFER NUNNALLY DC (CHIROPRACTOR)
(260) 450-3584
Entity
Organization
Contact information
Practice address
122 W WAYNE STREET, FORT WAYNE, IN 46802
(260) 450-3584
Mailing address
PO BOX 12033, FORT WAYNE, IN 46862-2033
(260) 450-3584
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
08002323A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200882740
—
IN
Enumeration date
05/05/2010
Last updated
05/06/2010
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