Provider Demographics
NPI:1093072100
Name:NATURAL BRIDGE CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:NATURAL BRIDGE CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ZACHARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:MCCALLISTER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-737-2225
Mailing Address - Street 1:1414 W LEXINGTON AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-1184
Mailing Address - Country:US
Mailing Address - Phone:859-737-2225
Mailing Address - Fax:859-737-0025
Practice Address - Street 1:1414 W LEXINGTON AVE
Practice Address - Street 2:SUITE C
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-1184
Practice Address - Country:US
Practice Address - Phone:859-737-2225
Practice Address - Fax:859-737-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-13
Last Update Date:2012-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5316111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty