Provider Demographics
NPI:1760637268
Name:WRIGHT FAMILY CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:WRIGHT FAMILY CHIROPRACTIC PSC
Other - Org Name:ELITE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUSTIN
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-475-1366
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-5245
Mailing Address - Country:US
Mailing Address - Phone:606-475-1366
Mailing Address - Fax:606-475-1367
Practice Address - Street 1:131 S CAROL MALONE BLVD STE D
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1810
Practice Address - Country:US
Practice Address - Phone:606-475-1366
Practice Address - Fax:606-475-1367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4990111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00822Medicare PIN