Provider Demographics
NPI:1609954775
Name:ATLAS-COCCYX CHIROPRACTIC CENTER, PSC
Entity Type:Organization
Organization Name:ATLAS-COCCYX CHIROPRACTIC CENTER, PSC
Other - Org Name:A-C CHIROPRACTIC CENTER, PSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRIMARY DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:GUTTING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-474-8266
Mailing Address - Street 1:166 MARY DR
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071
Mailing Address - Country:US
Mailing Address - Phone:270-474-8266
Mailing Address - Fax:
Practice Address - Street 1:166 MARY DR
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071
Practice Address - Country:US
Practice Address - Phone:270-474-8266
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3055111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYMW02079POtherEDI ANTHEM ID
KY0000001825100OtherANTHEM PROVIDER ID
KYMW02079POtherEDI ANTHEM ID
KYE8DKMedicare ID - Type UnspecifiedEDI SUBMISSION
KY1686501Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID