Provider Demographics
NPI:1558581280
Name:CAPITOL CHIROPRACTIC AND INJURY CENTER
Entity Type:Organization
Organization Name:CAPITOL CHIROPRACTIC AND INJURY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:S
Authorized Official - Last Name:CREMEANS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-223-2424
Mailing Address - Street 1:73 C. MICHAEL DAVENPORT BLVD.
Mailing Address - Street 2:SUITE 2
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601
Mailing Address - Country:US
Mailing Address - Phone:502-223-2424
Mailing Address - Fax:502-226-4005
Practice Address - Street 1:73 C. MICHAEL DAVENPORT BLVD.
Practice Address - Street 2:SUITE 2
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4475
Practice Address - Country:US
Practice Address - Phone:502-223-2424
Practice Address - Fax:502-226-4005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4982111N00000X
KY4930111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1558581280Medicare UPIN