Provider Demographics
NPI:1134229933
Name:PRESTON CHIROPRACTIC AND REHABILITATION LLC
Entity type:Organization
Organization Name:PRESTON CHIROPRACTIC AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MASSIMO
Authorized Official - Middle Name:
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-962-2277
Mailing Address - Street 1:7707 PRESTON HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3138
Mailing Address - Country:US
Mailing Address - Phone:502-962-2277
Mailing Address - Fax:502-962-1001
Practice Address - Street 1:7707 PRESTON HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-3138
Practice Address - Country:US
Practice Address - Phone:502-962-2277
Practice Address - Fax:502-962-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4783111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85002954Medicaid
KY9459Medicare PIN
KY85002954Medicaid