Provider Demographics
NPI:1972833358
Name:ALIGN CARE CHIROPRACTIC CENTER, PLLC
Entity Type:Organization
Organization Name:ALIGN CARE CHIROPRACTIC CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:606-706-0664
Mailing Address - Street 1:111 W HIGHWAY 80
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2725
Mailing Address - Country:US
Mailing Address - Phone:606-451-0564
Mailing Address - Fax:606-451-0565
Practice Address - Street 1:111 W HIGHWAY 80
Practice Address - Street 2:SUITE B
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2725
Practice Address - Country:US
Practice Address - Phone:606-451-0564
Practice Address - Fax:606-451-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-06
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4896111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
01286001OtherINDIVIDUAL PTAN
01286OtherGROUP PTAN
KY7100109460Medicaid
1568423614OtherINDIVIDUAL NPI
01286OtherGROUP PTAN