Provider Demographics
NPI:1699386433
Name:DAWSON SPINE & SPORT CHIROPRACTIC, INC
Entity Type:Organization
Organization Name:DAWSON SPINE & SPORT CHIROPRACTIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DO
Authorized Official - Prefix:
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:502-465-0055
Mailing Address - Street 1:410 W JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1114
Mailing Address - Country:US
Mailing Address - Phone:502-465-0055
Mailing Address - Fax:502-265-1215
Practice Address - Street 1:410 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1114
Practice Address - Country:US
Practice Address - Phone:502-465-0055
Practice Address - Fax:502-265-1215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NS0005XChiropractic ProvidersChiropractorSports PhysicianGroup - Single Specialty