Provider Demographics
NPI:1457385437
Name:CARTER COUNTY CHIROPRACTIC
Entity Type:Organization
Organization Name:CARTER COUNTY CHIROPRACTIC
Other - Org Name:AMERICAN HEALTH CENTERS OF GRAYSON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-622-7108
Mailing Address - Street 1:186 INTERSTATE DR
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:KY
Mailing Address - Zip Code:41143-1787
Mailing Address - Country:US
Mailing Address - Phone:606-475-0000
Mailing Address - Fax:606-474-0954
Practice Address - Street 1:186 INTERSTATE DR
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1787
Practice Address - Country:US
Practice Address - Phone:606-475-0000
Practice Address - Fax:606-474-0954
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CARTER COUNTY CHIROPRACTIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-10
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY5109111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85000818Medicaid
KY000000206230OtherANTHEM
KY85000818Medicaid
KY000000206230OtherANTHEM