Provider Demographics
NPI:1790745628
Name:BIANCO, FRIDA (DC)
Entity Type:Individual
Prefix:
First Name:FRIDA
Middle Name:
Last Name:BIANCO
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7707 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3138
Mailing Address - Country:US
Mailing Address - Phone:502-962-2277
Mailing Address - Fax:502-962-1001
Practice Address - Street 1:7707 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3138
Practice Address - Country:US
Practice Address - Phone:502-962-2277
Practice Address - Fax:502-962-1001
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4942111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003713Medicaid
KY000000376261OtherANTHEM BLUE CROSS BLUE SH
KY85003713Medicaid