Provider Demographics
NPI:1508043811
Name:BACK TO BASICS CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:BACK TO BASICS CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:SUTTON
Authorized Official - Last Name:ARNOLD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-236-5562
Mailing Address - Street 1:1420 HUSTONVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-2424
Mailing Address - Country:US
Mailing Address - Phone:859-236-5562
Mailing Address - Fax:859-236-5564
Practice Address - Street 1:1420 HUSTONVILLE RD
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-2424
Practice Address - Country:US
Practice Address - Phone:859-236-5562
Practice Address - Fax:859-236-5564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4865111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003127Medicaid
KY9157Medicare UPIN
KY9157Medicare PIN