Provider Demographics
NPI:1467886556
Name:CHIROPRACTIC HEALTH CENTER OF BARDSTOWN PLLC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER OF BARDSTOWN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-408-5440
Mailing Address - Street 1:214 W JOHN FITCH AVE
Mailing Address - Street 2:
Mailing Address - City:BARDSTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40004-1115
Mailing Address - Country:US
Mailing Address - Phone:502-350-1314
Mailing Address - Fax:502-350-1316
Practice Address - Street 1:214 W JOHN FITCH AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-1115
Practice Address - Country:US
Practice Address - Phone:859-239-0022
Practice Address - Fax:859-239-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100302090Medicaid