Provider Demographics
NPI:1164695706
Name:TRI COUNTY CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:TRI COUNTY CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:TONY
Authorized Official - Last Name:COMBS
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:606-528-5822
Mailing Address - Street 1:PO BOX 874
Mailing Address - Street 2:507 US HWY 25W
Mailing Address - City:CORBIN
Mailing Address - State:KY
Mailing Address - Zip Code:40702-0874
Mailing Address - Country:US
Mailing Address - Phone:606-528-5822
Mailing Address - Fax:606-528-6369
Practice Address - Street 1:507 US HIGHWAY 25 W
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-4525
Practice Address - Country:US
Practice Address - Phone:606-528-5822
Practice Address - Fax:606-528-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4544111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000112947OtherBC BS
KY85000065Medicaid
KY6086701OtherMEDICARE
KYU78737Medicare UPIN