Provider Demographics
NPI:1790819209
Name:BASTECKI, ANTHONY VICTOR (DC)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:VICTOR
Last Name:BASTECKI
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4750 HARTLAND PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-1558
Mailing Address - Country:US
Mailing Address - Phone:859-266-2223
Mailing Address - Fax:859-266-4926
Practice Address - Street 1:4750 HARTLAND PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-1558
Practice Address - Country:US
Practice Address - Phone:859-266-2223
Practice Address - Fax:859-266-4926
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3946111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85039469Medicaid
KYT20074Medicare UPIN
KY85039469Medicaid