Provider Demographics
NPI:1669507661
Name:CHIROPRACTIC HEALTH CENTER PSC
Entity type:Organization
Organization Name:CHIROPRACTIC HEALTH CENTER PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RECEPTIONIST
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-685-4200
Mailing Address - Street 1:4321 GATE WAY
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-2500
Mailing Address - Country:US
Mailing Address - Phone:270-685-4200
Mailing Address - Fax:270-926-6697
Practice Address - Street 1:4321 GATE WAY
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-2500
Practice Address - Country:US
Practice Address - Phone:270-685-4200
Practice Address - Fax:270-926-6697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00478Medicare PIN