Provider Demographics
NPI:1487817888
Name:PAGE, JUSTIN E (DC)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:PAGE
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 HURSTBOURNE VILLAGE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1856
Mailing Address - Country:US
Mailing Address - Phone:502-493-2400
Mailing Address - Fax:502-493-5050
Practice Address - Street 1:2304 HURSTBOURNE VILLAGE DR STE 100
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1856
Practice Address - Country:US
Practice Address - Phone:502-493-2400
Practice Address - Fax:502-493-5050
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5132111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0785507Medicare PIN
KY0719110Medicare PIN
KY00340006Medicare PIN