Provider Demographics
NPI:1679615322
Name:DANVILLE CHIROPRACTIC CENTER, INC.
Entity Type:Organization
Organization Name:DANVILLE CHIROPRACTIC CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF CHIROPRACTIC
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-236-2295
Mailing Address - Street 1:101 CITATION DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-9227
Mailing Address - Country:US
Mailing Address - Phone:859-236-2295
Mailing Address - Fax:859-238-0107
Practice Address - Street 1:101 CITATION DR
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-9227
Practice Address - Country:US
Practice Address - Phone:859-236-2295
Practice Address - Fax:859-238-0107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3802111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000195322OtherBCBS
KY607692OtherACN GROUP
KY85038024Medicaid
KY6095101Medicare ID - Type Unspecified
KY000000195322OtherBCBS