Provider Demographics
NPI:1962828483
Name:BRANDENBURG CHIROPRACTIC INC.
Entity Type:Organization
Organization Name:BRANDENBURG CHIROPRACTIC INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANS
Authorized Official - Middle Name:J
Authorized Official - Last Name:CESARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-422-4445
Mailing Address - Street 1:502 BYPASS RD
Mailing Address - Street 2:
Mailing Address - City:BRANDENBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40108-1702
Mailing Address - Country:US
Mailing Address - Phone:270-422-4445
Mailing Address - Fax:270-422-4927
Practice Address - Street 1:502 BYPASS RD
Practice Address - Street 2:
Practice Address - City:BRANDENBURG
Practice Address - State:KY
Practice Address - Zip Code:40108-1702
Practice Address - Country:US
Practice Address - Phone:270-422-4445
Practice Address - Fax:270-422-4927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-07
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4002111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1700937844Medicaid
KY1700937844Medicaid
KYT92095Medicare UPIN