Provider Demographics
NPI:1720434483
Name:THE LIGHT CLINIC, INC.
Entity Type:Organization
Organization Name:THE LIGHT CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:FIALA
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:502-330-4233
Mailing Address - Street 1:306 W MAIN ST
Mailing Address - Street 2:STE 609
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-1895
Mailing Address - Country:US
Mailing Address - Phone:502-330-4233
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:STE 609
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-1895
Practice Address - Country:US
Practice Address - Phone:502-330-4233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty