Provider Demographics
NPI:1659605517
Name:CHIROMED CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:CHIROMED CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:P
Authorized Official - Last Name:WIETFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-647-4600
Mailing Address - Street 1:60 STONECREST CT
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8155
Mailing Address - Country:US
Mailing Address - Phone:502-647-4600
Mailing Address - Fax:502-647-4607
Practice Address - Street 1:4123 TAYLOR BLVD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-2341
Practice Address - Country:US
Practice Address - Phone:502-363-7172
Practice Address - Fax:502-363-7174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4867111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY4568504744OtherPERSONAL NPI