Provider Demographics
NPI:1912053141
Name:FLORENCE CHIROPRACTIC CENTER INC.
Entity Type:Organization
Organization Name:FLORENCE CHIROPRACTIC CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:GRATKOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:859-525-2994
Mailing Address - Street 1:7830 CONNECTOR DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1435
Mailing Address - Country:US
Mailing Address - Phone:859-525-2994
Mailing Address - Fax:859-282-4192
Practice Address - Street 1:7830 CONNECTOR DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-1435
Practice Address - Country:US
Practice Address - Phone:859-525-2994
Practice Address - Fax:859-282-4192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4088111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYU18969Medicare UPIN
KY6088901Medicare ID - Type Unspecified