Provider Demographics
NPI:1952477267
Name:NORTH SHIVELY CHIROPRACTIC, LLC
Entity Type:Organization
Organization Name:NORTH SHIVELY CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:COPELAND
Authorized Official - Suffix:
Authorized Official - Credentials:D,C
Authorized Official - Phone:502-454-5000
Mailing Address - Street 1:1525 BARDSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40205-1109
Mailing Address - Country:US
Mailing Address - Phone:502-454-5000
Mailing Address - Fax:502-454-5225
Practice Address - Street 1:1525 BARDSTOWN RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-1109
Practice Address - Country:US
Practice Address - Phone:502-454-5000
Practice Address - Fax:502-454-5225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty