Provider Demographics
NPI:1891107520
Name:CHIROPRACTIC HEALTH CENTER, PSC
Entity Type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:REEVES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-431-2273
Mailing Address - Street 1:3631 DECOURSEY AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41015-1436
Mailing Address - Country:US
Mailing Address - Phone:859-431-2273
Mailing Address - Fax:859-431-6937
Practice Address - Street 1:3631 DECOURSEY AVE
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41015-1436
Practice Address - Country:US
Practice Address - Phone:859-431-2273
Practice Address - Fax:859-431-6937
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-29
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4162261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85001121Medicaid
KY85001121Medicaid