1588805733 NPI number — TRG INVESTMENTS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588805733 NPI number — TRG INVESTMENTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRG INVESTMENTS LLC
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:
WESTERN KENTUCKY CHIROPRACTIC CENTER
Provider Other Organization Name Type Code:
3
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:
1588805733
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1256 CAMPBELL LN
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
BOWLING GREEN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42104-1082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-904-3499
Provider Business Mailing Address Fax Number:
270-904-3472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1256 CAMPBELL LN
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
BOWLING GREEN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42104-1082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-904-3499
Provider Business Practice Location Address Fax Number:
270-904-3472
Provider Enumeration Date:
03/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
RATUSNY
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
VARONA
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
270-904-3499

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4813 , 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: 85002806 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6103101 . This is a "MEDICARE INDIVIDUAL" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000390128 . This is a "ANTHEM BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8889 . This is a "MEDICARE GROUP" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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