Provider Demographics
NPI:1497387864
Name:CENTRAL CITY CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:CENTRAL CITY CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:JOINES
Authorized Official - Suffix:II
Authorized Official - Credentials:DC
Authorized Official - Phone:270-754-1335
Mailing Address - Street 1:1731 W EVERLY BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-1833
Mailing Address - Country:US
Mailing Address - Phone:270-754-1335
Mailing Address - Fax:270-757-9478
Practice Address - Street 1:1731 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-1833
Practice Address - Country:US
Practice Address - Phone:270-754-1335
Practice Address - Fax:270-757-9478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty