Provider Demographics
NPI:1720171036
Name:CJ CHIROPRACTIC PSC
Entity Type:Organization
Organization Name:CJ CHIROPRACTIC PSC
Other - Org Name:AMERICAN CHIROPRACTIC-OKOLONA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:V
Authorized Official - Last Name:JACQUES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-937-7000
Mailing Address - Street 1:3101 FERN VALLEY RD
Mailing Address - Street 2:SUITE 13
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40213-3523
Mailing Address - Country:US
Mailing Address - Phone:502-938-7272
Mailing Address - Fax:502-968-7116
Practice Address - Street 1:3101 FERN VALLEY RD
Practice Address - Street 2:SUITE 13
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40213-3523
Practice Address - Country:US
Practice Address - Phone:502-938-7272
Practice Address - Fax:502-968-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4007111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7855Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER