Healthcare Provider Details

I. General information

NPI: 1801960042
Provider Name (Legal Business Name): BLUEGRASS CHIROPRACTIC CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606A BLOOMFIELD ROAD
BARDSTOWN KY
40004
US

IV. Provider business mailing address

606A BLOOMFIELD ROAD
BARDSTOWN KY
40004
US

V. Phone/Fax

Practice location:
  • Phone: 502-350-3700
  • Fax:
Mailing address:
  • Phone: 502-350-3700
  • Fax: 502-350-3701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number4521
License Number StateKY

VIII. Authorized Official

Name: DR. TERRY KEVYN MARMON
Title or Position: OWNER
Credential: DC
Phone: 502-350-3700