Provider Demographics
NPI:1922263904
Name:PREBLE CHIROPRACTIC
Entity Type:Organization
Organization Name:PREBLE CHIROPRACTIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:PREBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-222-7611
Mailing Address - Street 1:102 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:LA GRANGE
Mailing Address - State:KY
Mailing Address - Zip Code:40031-1428
Mailing Address - Country:US
Mailing Address - Phone:502-222-7611
Mailing Address - Fax:502-222-2321
Practice Address - Street 1:102 W MADISON ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:KY
Practice Address - Zip Code:40031-1428
Practice Address - Country:US
Practice Address - Phone:502-222-7611
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-19
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3668-R111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty