Provider Demographics
NPI:1295856821
Name:ESTES CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:ESTES CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:K
Authorized Official - Last Name:ESTES,
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:270-442-6352
Mailing Address - Street 1:3217 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4245
Mailing Address - Country:US
Mailing Address - Phone:270-442-6352
Mailing Address - Fax:270-443-3324
Practice Address - Street 1:3217 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4245
Practice Address - Country:US
Practice Address - Phone:270-442-6352
Practice Address - Fax:270-443-3324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4177111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0709Medicare PIN