Provider Demographics
NPI:1497964977
Name:DMAC, PSC
Entity Type:Organization
Organization Name:DMAC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-647-4600
Mailing Address - Street 1:30 STONECREST CT
Mailing Address - Street 2:STE 102
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8128
Mailing Address - Country:US
Mailing Address - Phone:502-647-4600
Mailing Address - Fax:502-647-4607
Practice Address - Street 1:30 STONECREST CT
Practice Address - Street 2:STE. 102
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8128
Practice Address - Country:US
Practice Address - Phone:502-647-4600
Practice Address - Fax:502-647-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2011-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4469111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1548282742OtherINDIVIDUAL NPI NUMBER