Provider Demographics
NPI:1831411594
Name:M.M.S.C.;INC
Entity type:Organization
Organization Name:M.M.S.C.;INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BUCKLES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-817-0817
Mailing Address - Street 1:7211 US 42
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1901
Mailing Address - Country:US
Mailing Address - Phone:859-817-0817
Mailing Address - Fax:859-817-1329
Practice Address - Street 1:7211 US 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1901
Practice Address - Country:US
Practice Address - Phone:859-817-0817
Practice Address - Fax:859-817-1329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4937111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2389204Medicaid
OH2389204Medicaid
OH4121701Medicare PIN