Provider Demographics
NPI:1376788133
Name:A. BASTECKI CHIROPRACTIC LTD
Entity Type:Organization
Organization Name:A. BASTECKI CHIROPRACTIC LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:V
Authorized Official - Last Name:BASTECKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-266-2223
Mailing Address - Street 1:3101 RICHMOND RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1599
Mailing Address - Country:US
Mailing Address - Phone:859-266-2223
Mailing Address - Fax:859-266-4926
Practice Address - Street 1:3101 RICHMOND RD
Practice Address - Street 2:SUITE202
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1599
Practice Address - Country:US
Practice Address - Phone:859-266-2223
Practice Address - Fax:859-266-4926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-09
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3946261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85039469Medicaid
KY85039469Medicaid