Provider Demographics
NPI:1851445704
Name:STAY WELL CHIROPRACTIC, INC.
Entity Type:Organization
Organization Name:STAY WELL CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LURA-BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HENSLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:740-867-4080
Mailing Address - Street 1:135 CENTRAL AVE
Mailing Address - Street 2:SUITE #1
Mailing Address - City:SOUTH WILLIAMSON
Mailing Address - State:KY
Mailing Address - Zip Code:41503-4165
Mailing Address - Country:US
Mailing Address - Phone:606-237-9355
Mailing Address - Fax:
Practice Address - Street 1:135 CENTRAL AVE
Practice Address - Street 2:SUITE #1
Practice Address - City:SOUTH WILLIAMSON
Practice Address - State:KY
Practice Address - Zip Code:41503-4165
Practice Address - Country:US
Practice Address - Phone:606-237-9355
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4290111N00000X
OH2280111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0202793Medicaid
OH9351661Medicare PIN
OH0202793Medicaid