Provider Demographics
NPI:1811246242
Name:INDEPENDENCE CHIROPRACTIC, INC.
Entity type:Organization
Organization Name:INDEPENDENCE CHIROPRACTIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SKINNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-363-1000
Mailing Address - Street 1:1922 WALTON NICHOOLSON ROAD
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41051
Mailing Address - Country:US
Mailing Address - Phone:859-363-1000
Mailing Address - Fax:859-363-0836
Practice Address - Street 1:1922 WALTON NICHOOLSON ROAD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KY
Practice Address - Zip Code:41051
Practice Address - Country:US
Practice Address - Phone:859-363-1000
Practice Address - Fax:859-363-0836
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-30
Last Update Date:2013-08-28
Deactivation Date:2013-05-21
Deactivation Code:
Reactivation Date:2013-08-27
Provider Licenses
StateLicense IDTaxonomies
KY4327111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty