Provider Demographics
NPI:1255469987
Name:STACHURSKI, JOHN THOMAS V (DC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:THOMAS
Last Name:STACHURSKI
Suffix:V
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2720 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-9470
Mailing Address - Country:US
Mailing Address - Phone:270-825-3995
Mailing Address - Fax:270-825-3895
Practice Address - Street 1:2720 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-9470
Practice Address - Country:US
Practice Address - Phone:270-825-3995
Practice Address - Fax:270-825-3895
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4967111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000380972OtherANTHAM
KY1229422OtherCHA
KY000000380972OtherBLUE CROSS & BLUE SHIELD
KY0993201Medicare ID - Type UnspecifiedMEDICARE