Provider Demographics
NPI:1255437406
Name:DR. JOHN D STRANGE, PSC
Entity type:Organization
Organization Name:DR. JOHN D STRANGE, PSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDRIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:270-273-5122
Mailing Address - Street 1:344 KY 81 NORTH
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:KY
Mailing Address - Zip Code:42327-9782
Mailing Address - Country:US
Mailing Address - Phone:270-273-5122
Mailing Address - Fax:270-273-9790
Practice Address - Street 1:344 KY 81 NORTH
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:KY
Practice Address - Zip Code:42327-9782
Practice Address - Country:US
Practice Address - Phone:270-273-5122
Practice Address - Fax:270-273-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4935111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85900561Medicaid
KY9672Medicare ID - Type Unspecified