Provider Demographics
NPI:1578758934
Name:ARTHUR PANGEMANAN DC LLC
Entity Type:Organization
Organization Name:ARTHUR PANGEMANAN DC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-839-7171
Mailing Address - Street 1:1004 DEWEY DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-1761
Mailing Address - Country:US
Mailing Address - Phone:502-839-7171
Mailing Address - Fax:502-839-4441
Practice Address - Street 1:1004 DEWEY DR
Practice Address - Street 2:SUITE C
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-1761
Practice Address - Country:US
Practice Address - Phone:502-839-7171
Practice Address - Fax:502-839-4441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9544Medicare PIN