Provider Demographics
NPI:1598039646
Name:WESTSIDE FAMILY CHIROPRACTIC AND REHABILITATION PSC
Entity Type:Organization
Organization Name:WESTSIDE FAMILY CHIROPRACTIC AND REHABILITATION PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:770-876-1090
Mailing Address - Street 1:1100 US HIGHWAY 127 S
Mailing Address - Street 2:BUILDING C. SUITE 1
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-4318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1100 US HIGHWAY 127 S
Practice Address - Street 2:BUILDING C. SUITE 1
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-4318
Practice Address - Country:US
Practice Address - Phone:502-581-9700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-06
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty