Provider Demographics
NPI:1770541955
Name:JEFFERSONTOWN CHIROPRACTIC CENTER
Entity type:Organization
Organization Name:JEFFERSONTOWN CHIROPRACTIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PFEFFER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-267-6444
Mailing Address - Street 1:10131 TAYLORSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JEFFERSONTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:40299-3649
Mailing Address - Country:US
Mailing Address - Phone:502-267-6444
Mailing Address - Fax:502-267-6445
Practice Address - Street 1:10131 TAYLORSVILLE RD
Practice Address - Street 2:
Practice Address - City:JEFFERSONTOWN
Practice Address - State:KY
Practice Address - Zip Code:40299-3649
Practice Address - Country:US
Practice Address - Phone:502-267-6444
Practice Address - Fax:502-267-6445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2007-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3812111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000069294OtherANTHEM
KY1116809OtherPASSPORT
KY85036549Medicaid