Provider Demographics
NPI:1679901680
Name:SB CHIROPRACTIC DBA EAST BROADWAY CHIROPRACTIC & REHABILITATION
Entity Type:Organization
Organization Name:SB CHIROPRACTIC DBA EAST BROADWAY CHIROPRACTIC & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:GITTINGS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-681-6800
Mailing Address - Street 1:418 E BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1706
Mailing Address - Country:US
Mailing Address - Phone:502-681-6800
Mailing Address - Fax:
Practice Address - Street 1:418 E BROADWAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1706
Practice Address - Country:US
Practice Address - Phone:502-681-6800
Practice Address - Fax:502-681-6868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SB CHIROPRACTIC DBA EAST BROADWAY CHIROPRACTIC & REHABILITATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4507111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty