Provider Demographics
NPI:1093851453
Name:GRAYSON CHIROPRACTIC CENTER PSC INC
Entity Type:Organization
Organization Name:GRAYSON CHIROPRACTIC CENTER PSC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOLF
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-474-6445
Mailing Address - Street 1:308 HORTON ST
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1319
Mailing Address - Country:US
Mailing Address - Phone:606-474-6445
Mailing Address - Fax:606-474-6445
Practice Address - Street 1:308 HORTON ST
Practice Address - Street 2:SUITE # 2
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143
Practice Address - Country:US
Practice Address - Phone:606-474-6445
Practice Address - Fax:606-474-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4234261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85042349Medicaid
KY85042349Medicaid
KY0960001Medicare PIN