Provider Demographics
NPI:1558314377
Name:WEST LOUISVILLE CHIROPRACTIC INC
Entity Type:Organization
Organization Name:WEST LOUISVILLE CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:EHRHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-775-2273
Mailing Address - Street 1:2001 W BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40203-3595
Mailing Address - Country:US
Mailing Address - Phone:502-775-2273
Mailing Address - Fax:
Practice Address - Street 1:2001 W BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40203-3595
Practice Address - Country:US
Practice Address - Phone:502-775-2273
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001618Medicaid
KY00044Medicare PIN
KY6030560001Medicare NSC
KY85001618Medicaid