OrganizationBroadway Plaza Pain Relief CenterChiropractorChiropractic ProvidersPractice Address5360 Broadway, Merrillville, IN 46410-1555(219) 884-3250PECOS EnrollmentBased on the most recent information from CMS, provider Broadway Plaza Pain Relief Center does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1861761959Provider TypeOrganizationFull NameBroadway Plaza Pain Relief CenterSubpartNoEnumeration Date12/20/2011Last Updated12/20/2011Contact InformationPractice LocationPractice Address5360 Broadway, Merrillville, IN 46410-1555Phone(219) 884-3250Fax(219) 884-3828Mailing LocationMailing Address5360 Broadway, Merrillville, IN 46410-1555Phone(219) 884-3250Fax(219) 884-3828Authorized OfficialNameHall, Robert E (Chiropractic)Phone(219) 884-3250Provider TaxonomiesCodeDescriptionLicenseCode111N00000XPrimaryDescriptionChiropractorChiropractic ProvidersLicense08001395AIndianaProvider IdentifiersIDDescriptionIssuerID100338150DescriptionMedicaidIssuerUnlistedIndiana