Provider Demographics
NPI:1629126347
Name:TAYLOR COUNTY CHIROPRACTIC INC
Entity Type:Organization
Organization Name:TAYLOR COUNTY CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JANNA
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-465-5200
Mailing Address - Street 1:100 GREENBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:CAMPBELLSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42718-9613
Mailing Address - Country:US
Mailing Address - Phone:270-465-5200
Mailing Address - Fax:
Practice Address - Street 1:100 GREENBRIAR DR
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-9613
Practice Address - Country:US
Practice Address - Phone:270-465-5200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5035111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000503977OtherANTHEM BCBS KY
KY612101900OtherDEPT. OF LABOR
KY000000503977OtherANTHEM BCBS KY