Provider Demographics
NPI:1720253610
Name:DIXIE CHIROPRACTIC OFFICE, P.S.C.
Entity Type:Organization
Organization Name:DIXIE CHIROPRACTIC OFFICE, P.S.C.
Other - Org Name:ALLIANCE CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEHDI
Authorized Official - Middle Name:
Authorized Official - Last Name:GHAYOUMI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-499-1189
Mailing Address - Street 1:4615 DIXIE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-3682
Mailing Address - Country:US
Mailing Address - Phone:502-499-1189
Mailing Address - Fax:
Practice Address - Street 1:4615 DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-3682
Practice Address - Country:US
Practice Address - Phone:502-499-1189
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4227111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty