1306258488 NPI number — BACK TALK CHIROPRACTIC PSC

Table of content: (NPI 1306258488)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306258488 NPI number — BACK TALK CHIROPRACTIC PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BACK TALK CHIROPRACTIC PSC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BACK TALK CHIROPRACTIC, PSC
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1306258488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 E NEW CIRCLE RD STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40505-4256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-309-0377
Provider Business Mailing Address Fax Number:
859-309-0381

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 E NEW CIRCLE RD STE 160
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40505-4256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-309-0377
Provider Business Practice Location Address Fax Number:
859-309-0381
Provider Enumeration Date:
05/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
TOLSON
Authorized Official First Name:
TAMERA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
859-309-0377

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5249 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000000722788 . This is a "ANTHEM" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K015320 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 1136817 . This is a "AMERICAN SPECIALTY HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 664895 . This is a "WELLCARE OF KENTUCKY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100186170 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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