Provider Demographics
NPI:1851547574
Name:COLOMBO CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:COLOMBO CHIROPRACTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:COLOMBO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-261-0713
Mailing Address - Street 1:9549 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2734
Mailing Address - Country:US
Mailing Address - Phone:502-261-0713
Mailing Address - Fax:502-261-0771
Practice Address - Street 1:9549 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2734
Practice Address - Country:US
Practice Address - Phone:502-261-0713
Practice Address - Fax:502-261-0771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-13
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4656111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9642Medicare PIN