Provider Demographics
NPI:1447461132
Name:NEWBURGH CHIROPRACTIC PSC
Entity type:Organization
Organization Name:NEWBURGH CHIROPRACTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:P
Authorized Official - Last Name:TYMCHAK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:812-858-1008
Mailing Address - Street 1:8211 W STATE ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-2534
Mailing Address - Country:US
Mailing Address - Phone:812-858-1008
Mailing Address - Fax:812-858-1001
Practice Address - Street 1:8211 W STATE ROUTE 66
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-2534
Practice Address - Country:US
Practice Address - Phone:812-858-1008
Practice Address - Fax:812-858-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2010-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002011A111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN116439OtherSIHO
IN200366440AMedicaid
IN000000314297OtherANTHEM
IN000000314297OtherANTHEM
INU89446Medicare UPIN
IN5335030001Medicare NSC