Provider Demographics
NPI:1639340912
Name:BLUEGRASS CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BLUEGRASS CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:LEON
Authorized Official - Last Name:PELTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:859-254-0059
Mailing Address - Street 1:1132 WINCHESTER ROAD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40505
Mailing Address - Country:US
Mailing Address - Phone:859-254-0059
Mailing Address - Fax:859-254-1033
Practice Address - Street 1:1132 WINCHESTER RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-4042
Practice Address - Country:US
Practice Address - Phone:859-254-0059
Practice Address - Fax:859-254-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3973111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK019971Medicare PIN
KYK019970Medicare PIN