Provider Demographics
NPI:1831387190
Name:OLLIS CHIROPRACTIC, PSC
Entity type:Organization
Organization Name:OLLIS CHIROPRACTIC, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLLIS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-412-8580
Mailing Address - Street 1:10000 BROWNSBORO RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3900
Mailing Address - Country:US
Mailing Address - Phone:502-412-8580
Mailing Address - Fax:502-412-8862
Practice Address - Street 1:10000 BROWNSBORO RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3900
Practice Address - Country:US
Practice Address - Phone:502-412-8580
Practice Address - Fax:502-412-8862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4708111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0727201Medicare UPIN
KY7272Medicare PIN