MEDICARE: PRIORITY HEALTH CHIROPRACTIC L.L.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	3360	OH

General Provider Information

NPI Number	:	1184888729
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIORITY HEALTH CHIROPRACTIC L.L.C.

Provider Business Mailing Address
First Line	:	881 W NORTH BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1340
Country	:	US
Telephone Number	:	513-242-6472
Fax Number	:	513-242-2196

Provider Business Practice Location Address
First Line	:	881 W NORTH BEND RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45224-1340
Country	:	US
Telephone Number	:	513-242-6472
Fax Number	:	513-242-2196

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KENYON DARNELL HACKWORTH
Credential	:	D.C.
Telephone Number	:	513-242-6472

Provider Enumeration Date	:	07/14/2008
Last Update Date	:	07/14/2008

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