Provider Demographics
NPI:1245384031
Name:CASEY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CASEY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:CASEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-769-5400
Mailing Address - Street 1:2865 RING RD STE 110
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-9114
Mailing Address - Country:US
Mailing Address - Phone:270-769-5400
Mailing Address - Fax:270-769-0567
Practice Address - Street 1:2865 RING RD STE 110
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-9114
Practice Address - Country:US
Practice Address - Phone:270-769-5400
Practice Address - Fax:270-769-0567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4477111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU84081Medicare UPIN
KY9998Medicare ID - Type UnspecifiedMEDICARE GROUP