Provider Demographics
NPI:1164823399
Name:BRIAN ANDERSON, DC, LLC
Entity Type:Organization
Organization Name:BRIAN ANDERSON, DC, LLC
Other - Org Name:KENTUCKY INJURY CHIROPRACTIC & REHABILITATION, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-451-0484
Mailing Address - Street 1:1941 BISHOP LN
Mailing Address - Street 2:SUITE 508
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1922
Mailing Address - Country:US
Mailing Address - Phone:502-451-0484
Mailing Address - Fax:502-451-0778
Practice Address - Street 1:1941 BISHOP LN
Practice Address - Street 2:SUITE 508
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1922
Practice Address - Country:US
Practice Address - Phone:502-451-0484
Practice Address - Fax:502-451-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4679111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty