Provider Demographics
NPI:1184886251
Name:ACTIVE BODY CHIROPRACTIC AND INJURY CENTER OF RICHMOND, PLLC
Entity type:Organization
Organization Name:ACTIVE BODY CHIROPRACTIC AND INJURY CENTER OF RICHMOND, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIROPRACTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELDON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SHARPE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-626-0075
Mailing Address - Street 1:1000 COMMERCIAL DR STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-9681
Mailing Address - Country:US
Mailing Address - Phone:859-626-0075
Mailing Address - Fax:859-626-0071
Practice Address - Street 1:1000 COMMERCIAL DR STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-9681
Practice Address - Country:US
Practice Address - Phone:859-626-0075
Practice Address - Fax:859-626-0071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4912111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003671Medicaid