Provider Demographics
NPI:1952649352
Name:RESTORED CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:RESTORED CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:MASON
Authorized Official - Last Name:CLAPP
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-247-7677
Mailing Address - Street 1:424 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:KY
Mailing Address - Zip Code:42066-2610
Mailing Address - Country:US
Mailing Address - Phone:270-247-7677
Mailing Address - Fax:
Practice Address - Street 1:424 S 9TH ST
Practice Address - Street 2:
Practice Address - City:MAYFIELD
Practice Address - State:KY
Practice Address - Zip Code:42066-2610
Practice Address - Country:US
Practice Address - Phone:270-247-7677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty