Provider Demographics
NPI:1407944606
Name:KRAWCHISON, JOHN R (DC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:KRAWCHISON
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 TAYLOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-2371
Mailing Address - Country:US
Mailing Address - Phone:502-364-7246
Mailing Address - Fax:502-364-7245
Practice Address - Street 1:4107 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2371
Practice Address - Country:US
Practice Address - Phone:502-364-7246
Practice Address - Fax:502-364-7245
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ININ08001209111NR0200X, 111NR0400X
KY3897111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NR0400XChiropractic ProvidersChiropractorRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100074680Medicaid
IN200106150Medicaid
IN730770EMedicare PIN
KY00947001Medicare PIN
IN200106150Medicaid