1154363562 NPI number — CYNTHIANA CHIROPRACTIC CENTER PLLC

Table of content: (NPI 1154363562)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154363562 NPI number — CYNTHIANA CHIROPRACTIC CENTER PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CYNTHIANA CHIROPRACTIC CENTER PLLC
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:
Provider Other Organization Name Type Code:
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:
1154363562
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1050 US HIGHWAY 27 S
Provider Second Line Business Mailing Address:
#1
Provider Business Mailing Address City Name:
CYNTHIANA
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41031-5997
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-508-3200
Provider Business Mailing Address Fax Number:
859-508-3201

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 US HIGHWAY 27 S
Provider Second Line Business Practice Location Address:
#1
Provider Business Practice Location Address City Name:
CYNTHIANA
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41031-5997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-508-3200
Provider Business Practice Location Address Fax Number:
859-508-3201
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULZ
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
C
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
859-508-3200

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  4703 , 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: 6094511 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 85002798 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com