Provider Demographics
NPI:1881790921
Name:CARROLLTON CHIROPRACTIC PSC
Entity type:Organization
Organization Name:CARROLLTON CHIROPRACTIC PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNWR / DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EVERRETT
Authorized Official - Last Name:KATES
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:502-732-6000
Mailing Address - Street 1:2478 US HIGHWAY 227
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CARROLLTON
Mailing Address - State:KY
Mailing Address - Zip Code:41008-8048
Mailing Address - Country:US
Mailing Address - Phone:502-732-6000
Mailing Address - Fax:502-732-0125
Practice Address - Street 1:2478 US HIGHWAY 227
Practice Address - Street 2:SUITE #1
Practice Address - City:CARROLLTON
Practice Address - State:KY
Practice Address - Zip Code:41008-8048
Practice Address - Country:US
Practice Address - Phone:502-732-6000
Practice Address - Fax:502-732-0125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4619111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY85003523Medicaid
KY85003523Medicaid
6101501Medicare ID - Type Unspecified