Provider Demographics
NPI:1407989296
Name:JL CHIROPRACTIC, P.S.C.
Entity Type:Organization
Organization Name:JL CHIROPRACTIC, P.S.C.
Other - Org Name:AMERICAN CHIROPRACTIC - HILLVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-957-2008
Mailing Address - Street 1:1889 OLD PRESTON HWY N
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3291
Mailing Address - Country:US
Mailing Address - Phone:502-957-2008
Mailing Address - Fax:502-957-2078
Practice Address - Street 1:1889 OLD PRESTON HWY N
Practice Address - Street 2:SUITE 1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3291
Practice Address - Country:US
Practice Address - Phone:502-957-2008
Practice Address - Fax:502-957-2078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00340Medicare PIN