Provider Demographics
NPI:1033277298
Name:GABLE CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:GABLE CHIROPRACTIC, PSC
Other - Org Name:WEST PORT CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-326-5000
Mailing Address - Street 1:9425 WESTPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2219
Mailing Address - Country:US
Mailing Address - Phone:502-326-5000
Mailing Address - Fax:502-326-9730
Practice Address - Street 1:9407 WESTPORT RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2299
Practice Address - Country:US
Practice Address - Phone:502-326-5000
Practice Address - Fax:502-326-5054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4773111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1C 9371OtherMEDICARE