Provider Demographics
NPI:1184888729
Name:PRIORITY HEALTH CHIROPRACTIC L.L.C.
Entity type:Organization
Organization Name:PRIORITY HEALTH CHIROPRACTIC L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENYON
Authorized Official - Middle Name:DARNELL
Authorized Official - Last Name:HACKWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:513-242-6472
Mailing Address - Street 1:881 W NORTH BEND RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45224-1340
Mailing Address - Country:US
Mailing Address - Phone:513-242-6472
Mailing Address - Fax:513-242-2196
Practice Address - Street 1:881 W NORTH BEND RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45224-1340
Practice Address - Country:US
Practice Address - Phone:513-242-6472
Practice Address - Fax:513-242-2196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3360111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPR9364311Medicare PIN