Provider Demographics
NPI:1689914475
Name:ALBANY FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:ALBANY FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-408-5440
Mailing Address - Street 1:701 BURKESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-1654
Mailing Address - Country:US
Mailing Address - Phone:606-387-5793
Mailing Address - Fax:606-387-0519
Practice Address - Street 1:701 BURKESVILLE RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1654
Practice Address - Country:US
Practice Address - Phone:606-387-5793
Practice Address - Fax:606-387-0519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-15
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100244020Medicaid