Provider Demographics
NPI:1598789091
Name:ASHLAND CHIROPRACTIC CENTER INC
Entity Type:Organization
Organization Name:ASHLAND CHIROPRACTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SWANN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-329-8080
Mailing Address - Street 1:613 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-2617
Mailing Address - Country:US
Mailing Address - Phone:606-329-8080
Mailing Address - Fax:606-325-8550
Practice Address - Street 1:613 13TH ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2617
Practice Address - Country:US
Practice Address - Phone:606-329-8080
Practice Address - Fax:606-325-8550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4525111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000076184OtherANTHEM BCBS
KY85000818Medicaid
U80036Medicare UPIN
KY85000818Medicaid