Provider Demographics
NPI:1467880963
Name:ON THE RIVER CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:ON THE RIVER CHIROPRACTIC PSC
Other - Org Name:HEALTHSOURCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:
Authorized Official - Last Name:THALER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-724-4247
Mailing Address - Street 1:2869 US HIGHWAY 41 N
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2048
Mailing Address - Country:US
Mailing Address - Phone:270-724-4247
Mailing Address - Fax:
Practice Address - Street 1:2869 US HIGHWAY 41 N
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:KY
Practice Address - Zip Code:42420-2048
Practice Address - Country:US
Practice Address - Phone:270-724-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty