Provider Demographics
NPI:1548430747
Name:CRACKERBACK, INC
Entity Type:Organization
Organization Name:CRACKERBACK, INC
Other - Org Name:FAMILY CARE CHIROPRACTIC, HILLVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RODRICK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-957-1021
Mailing Address - Street 1:1679 OLD PRESTON HWY N
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-3297
Mailing Address - Country:US
Mailing Address - Phone:502-957-1021
Mailing Address - Fax:502-957-1703
Practice Address - Street 1:1679 OLD PRESTON HWY N
Practice Address - Street 2:SUITE 6
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40229-3297
Practice Address - Country:US
Practice Address - Phone:502-957-1021
Practice Address - Fax:502-957-1703
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4365111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY8907OtherMEDICARE GROUP
KYDC2130OtherRAILROAD MEDICARE GROUP