Provider Demographics
NPI:1164075180
Name:MAX FAMILY CHIROPRACTIC , REBECCA PANGEMANAN DC LLC
Entity Type:Organization
Organization Name:MAX FAMILY CHIROPRACTIC , REBECCA PANGEMANAN DC LLC
Other - Org Name:MAX FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:PANGEMANAN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-303-7000
Mailing Address - Street 1:108 PASADENA DR STE 110
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-2966
Mailing Address - Country:US
Mailing Address - Phone:859-303-7000
Mailing Address - Fax:859-303-5001
Practice Address - Street 1:108 PASADENA DR STE 110
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2966
Practice Address - Country:US
Practice Address - Phone:859-303-7000
Practice Address - Fax:859-303-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100638340Medicaid