Provider Demographics
NPI:1952746505
Name:LAWRENCEBURG FAMILY CHIROPRACTIC PLLC
Entity Type:Organization
Organization Name:LAWRENCEBURG FAMILY CHIROPRACTIC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPLIANCE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TOSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCORMACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-408-5440
Mailing Address - Street 1:1004 BYPASS S
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:40342-8046
Mailing Address - Country:US
Mailing Address - Phone:502-839-7774
Mailing Address - Fax:502-839-7761
Practice Address - Street 1:1004 BYPASS S
Practice Address - Street 2:SUITE 5
Practice Address - City:LAWRENCEBURG
Practice Address - State:KY
Practice Address - Zip Code:40342-8046
Practice Address - Country:US
Practice Address - Phone:502-839-7774
Practice Address - Fax:502-839-7761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-08
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254410Medicaid