Provider Demographics
NPI:1639554256
Name:APPALACHIAN CHIROPRACTIC, PSC
Entity Type:Organization
Organization Name:APPALACHIAN CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JARROD
Authorized Official - Middle Name:
Authorized Official - Last Name:THACKER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-422-2515
Mailing Address - Street 1:26317 US HIGHWAY 119 N
Mailing Address - Street 2:
Mailing Address - City:BELFRY
Mailing Address - State:KY
Mailing Address - Zip Code:41514-7417
Mailing Address - Country:US
Mailing Address - Phone:606-519-3543
Mailing Address - Fax:
Practice Address - Street 1:26317 US HIGHWAY 119 N
Practice Address - Street 2:
Practice Address - City:BELFRY
Practice Address - State:KY
Practice Address - Zip Code:41514-7417
Practice Address - Country:US
Practice Address - Phone:606-519-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-24
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5465111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty