Provider Demographics
NPI:1720479827
Name:STATOM CHIROPRACTIC INC
Entity Type:Organization
Organization Name:STATOM CHIROPRACTIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:STATOM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-822-1668
Mailing Address - Street 1:2210 MEADOW DR
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1323
Mailing Address - Country:US
Mailing Address - Phone:502-822-1668
Mailing Address - Fax:844-295-2789
Practice Address - Street 1:2210 MEADOW DR
Practice Address - Street 2:SUITE 5
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40218-1323
Practice Address - Country:US
Practice Address - Phone:502-822-1668
Practice Address - Fax:844-295-2789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty