Provider Demographics
NPI:1134468028
Name:WEST DIXIE SPINE AND REHAB CENTERS
Entity Type:Organization
Organization Name:WEST DIXIE SPINE AND REHAB CENTERS
Other - Org Name:LOUISVILLE CHIROPRACTIC AND INJURY CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:561-729-7092
Mailing Address - Street 1:6661 DIXIE HWY STE 4, BOX 311
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5105 B DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216
Practice Address - Country:US
Practice Address - Phone:502-449-5955
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5355111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty