MEDICARE: SOUTHERN PARKWAY CHIROPRACTIC PLLC

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

General Provider Information

NPI Number	:	1427464619
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN PARKWAY CHIROPRACTIC PLLC

Provider Business Mailing Address
First Line	:	4602 SOUTHERN PKWY STE 1A
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4602 SOUTHERN PKWY STE 1A
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-361-1159
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CURTIS BOBIER
Credential	:
Telephone Number	:	502-361-1159

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	07/08/2014

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