Provider Demographics
NPI:1689215402
Name:IROQUOIS INJURY CARE CHIROPRACTIC CENTER PSC
Entity Type:Organization
Organization Name:IROQUOIS INJURY CARE CHIROPRACTIC CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAWCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-883-0045
Mailing Address - Street 1:5324 SOUTH 3RD STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-2690
Mailing Address - Country:US
Mailing Address - Phone:502-883-0045
Mailing Address - Fax:502-883-0049
Practice Address - Street 1:5324 SOUTH 3RD STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40214-2690
Practice Address - Country:US
Practice Address - Phone:502-883-0045
Practice Address - Fax:502-883-0049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-02
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty