Provider Demographics
NPI:1871732164
Name:STAGGERS CHIROPRACTIC WELLNESS CENTER INC
Entity type:Organization
Organization Name:STAGGERS CHIROPRACTIC WELLNESS CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHENITA
Authorized Official - Middle Name:
Authorized Official - Last Name:STAGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:219-924-2112
Mailing Address - Street 1:801 W GLEN PARK AVE
Mailing Address - Street 2:
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2087
Mailing Address - Country:US
Mailing Address - Phone:219-924-2112
Mailing Address - Fax:219-924-2113
Practice Address - Street 1:801 W GLEN PARK AVE
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2087
Practice Address - Country:US
Practice Address - Phone:219-924-2112
Practice Address - Fax:219-924-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-11
Last Update Date:2009-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08002399A261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN259520OtherMEDICARE PTAN