Provider Demographics
NPI:1427416890
Name:CHADWICK MANAGEMENT PSC
Entity Type:Organization
Organization Name:CHADWICK MANAGEMENT PSC
Other - Org Name:FAULKNER FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:CHADWICK
Authorized Official - Last Name:FAULKNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-576-4432
Mailing Address - Street 1:113 MALONEY WAY
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9553
Mailing Address - Country:US
Mailing Address - Phone:859-576-4432
Mailing Address - Fax:859-305-1639
Practice Address - Street 1:113 MALONEY WAY
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9553
Practice Address - Country:US
Practice Address - Phone:859-576-4432
Practice Address - Fax:859-305-1639
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-01
Last Update Date:2021-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100609430Medicaid