Provider Demographics
NPI:1356655260
Name:KY CHIROPRACTIC, L.L.C.
Entity Type:Organization
Organization Name:KY CHIROPRACTIC, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-821-1500
Mailing Address - Street 1:2926 CANAL ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6304
Mailing Address - Country:US
Mailing Address - Phone:504-821-1500
Mailing Address - Fax:504-821-7520
Practice Address - Street 1:2926 CANAL ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6304
Practice Address - Country:US
Practice Address - Phone:504-821-1500
Practice Address - Fax:504-821-7520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA489302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization