Provider Demographics
NPI:1861682676
Name:GANESH CHIROPRACTIC, PLLC
Entity Type:Organization
Organization Name:GANESH CHIROPRACTIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:
Authorized Official - First Name:SANTOSH
Authorized Official - Middle Name:K
Authorized Official - Last Name:GANESH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-781-1000
Mailing Address - Street 1:2515 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1317
Mailing Address - Country:US
Mailing Address - Phone:859-781-1000
Mailing Address - Fax:859-572-0244
Practice Address - Street 1:2515 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1317
Practice Address - Country:US
Practice Address - Phone:859-781-1000
Practice Address - Fax:859-572-0244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-27
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4684111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002012Medicaid
KY85002012Medicaid