Provider Demographics
NPI:1811921083
Name:SHEPHERDSVILLE CHIROPRACTIC, LLC
Entity type:Organization
Organization Name:SHEPHERDSVILLE CHIROPRACTIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:R
Authorized Official - Last Name:LUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-543-2225
Mailing Address - Street 1:149 HIGHWAY 44 E
Mailing Address - Street 2:
Mailing Address - City:SHEPHERDSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40165-6001
Mailing Address - Country:US
Mailing Address - Phone:502-543-2225
Mailing Address - Fax:502-921-4528
Practice Address - Street 1:149 HIGHWAY 44 E
Practice Address - Street 2:
Practice Address - City:SHEPHERDSVILLE
Practice Address - State:KY
Practice Address - Zip Code:40165-6001
Practice Address - Country:US
Practice Address - Phone:502-543-2225
Practice Address - Fax:502-921-4528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4667111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50011058OtherPASSPORT
KY85002319Medicaid
KYDG3127OtherPALMETTO RAILROAD MEDICARE
KY2734879000OtherPASSPORT ADVANTAGE
KY00025Medicare PIN