Provider Demographics
NPI:1275666067
Name:GARNETT CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:GARNETT CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC-CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:GARNETT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-628-3490
Mailing Address - Street 1:230 HIGHWAY 51 SOUTH
Mailing Address - Street 2:PO BOX 593
Mailing Address - City:BARDWELL
Mailing Address - State:KY
Mailing Address - Zip Code:42023
Mailing Address - Country:US
Mailing Address - Phone:270-628-3490
Mailing Address - Fax:270-628-3810
Practice Address - Street 1:230 HIGHWAY 51 SOUTH
Practice Address - Street 2:
Practice Address - City:BARDWELL
Practice Address - State:KY
Practice Address - Zip Code:42023
Practice Address - Country:US
Practice Address - Phone:270-628-3490
Practice Address - Fax:270-628-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3953111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU21014Medicare UPIN
KY0295Medicare PIN