Provider Demographics
NPI:1275720690
Name:WELLNESS FAMILY CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:WELLNESS FAMILY CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:STACHURSKI
Authorized Official - Suffix:V
Authorized Official - Credentials:DC
Authorized Official - Phone:270-825-3995
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-30
Last Update Date:2007-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYDE3553OtherRAILROAD MEDICARE
KY1229422OtherCHA
KY000000380972OtherBLUE CROSS BLUE SHIELD
KYDE3553OtherRAILROAD MEDICARE