Provider Demographics
NPI:1467916379
Name:MODERN CHIROPRACTIC AND INJURY CARE
Entity Type:Organization
Organization Name:MODERN CHIROPRACTIC AND INJURY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-554-3800
Mailing Address - Street 1:11106 DECIMAL DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2440
Mailing Address - Country:US
Mailing Address - Phone:502-554-3800
Mailing Address - Fax:502-614-6148
Practice Address - Street 1:11106 DECIMAL DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2440
Practice Address - Country:US
Practice Address - Phone:502-554-3800
Practice Address - Fax:502-614-6148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-24
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100584900Medicaid