Provider Demographics
NPI:1528556032
Name:INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER
Entity Type:Organization
Organization Name:INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER
Other - Org Name:TONY DELK CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-545-0043
Mailing Address - Street 1:2725 JAMES SANDERS BLVD.
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8501
Mailing Address - Country:US
Mailing Address - Phone:270-554-5114
Mailing Address - Fax:270-215-4834
Practice Address - Street 1:2537 LARKIN RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503
Practice Address - Country:US
Practice Address - Phone:859-545-0043
Practice Address - Fax:502-264-9500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATED MEDICINE AND CHIROPRACTIC REGENERATION CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty