Provider Demographics
NPI:1285832758
Name:VERSAILLES CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:VERSAILLES CHIROPRACTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GLADDIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-879-0024
Mailing Address - Street 1:260 CROSSFIELD DR UNIT 2
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1596
Mailing Address - Country:US
Mailing Address - Phone:859-879-0024
Mailing Address - Fax:859-879-1102
Practice Address - Street 1:260 CROSSFIELD DR UNIT 2
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1596
Practice Address - Country:US
Practice Address - Phone:859-879-0024
Practice Address - Fax:859-879-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00383Medicare PIN