Provider Demographics
NPI:1972655272
Name:FAMILY CHIROPRACTIC OF DANVILLE PSC
Entity Type:Organization
Organization Name:FAMILY CHIROPRACTIC OF DANVILLE PSC
Other - Org Name:DANVILLE FAMILY CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MONGEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-239-0022
Mailing Address - Street 1:434 W WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-1846
Mailing Address - Country:US
Mailing Address - Phone:859-239-0022
Mailing Address - Fax:859-239-0044
Practice Address - Street 1:434 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-1846
Practice Address - Country:US
Practice Address - Phone:859-239-0022
Practice Address - Fax:859-239-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6919Medicare PIN