Provider Demographics
NPI:1154468932
Name:SHELBYVILLE CHIROPRACTIC CENTER, P.S.C.
Entity Type:Organization
Organization Name:SHELBYVILLE CHIROPRACTIC CENTER, P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR,BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:LEONARD
Authorized Official - Last Name:RIBENBOIM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-633-1574
Mailing Address - Street 1:26 MACK WALTERS RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1738
Mailing Address - Country:US
Mailing Address - Phone:502-633-1574
Mailing Address - Fax:502-647-9144
Practice Address - Street 1:26 MACK WALTERS RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1738
Practice Address - Country:US
Practice Address - Phone:502-633-1574
Practice Address - Fax:502-647-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY04135111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000313Medicaid
KY85000313Medicaid