Provider Demographics
NPI:1720149842
Name:ASTON CHIROPRACTIC BACK PAIN CENTER
Entity Type:Organization
Organization Name:ASTON CHIROPRACTIC BACK PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:FERNANDO
Authorized Official - Last Name:ASTON
Authorized Official - Suffix:III
Authorized Official - Credentials:DC, BS
Authorized Official - Phone:502-458-0000
Mailing Address - Street 1:2222 HIKES LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-2204
Mailing Address - Country:US
Mailing Address - Phone:502-458-0000
Mailing Address - Fax:502-458-2521
Practice Address - Street 1:2222 HIKES LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-2204
Practice Address - Country:US
Practice Address - Phone:502-458-0000
Practice Address - Fax:502-458-2521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY500004284Medicaid
KY50004286Medicaid
KYU29135Medicare UPIN
KY50004286Medicaid