Provider Demographics
NPI:1053951137
Name:RESTORATION FAMILY CHIROPRACTIC
Entity type:Organization
Organization Name:RESTORATION FAMILY CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILEAH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:VAN MATRE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:574-870-1375
Mailing Address - Street 1:6351 BIRDS EYE DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46203-6171
Mailing Address - Country:US
Mailing Address - Phone:574-870-1375
Mailing Address - Fax:
Practice Address - Street 1:5915 S EMERSON AVE STE 400
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-1972
Practice Address - Country:US
Practice Address - Phone:812-200-6204
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-07
Last Update Date:2020-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty