Healthcare Provider Details

I. General information

NPI: 1639554256
Provider Name (Legal Business Name): APPALACHIAN CHIROPRACTIC, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 07/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26317 US HIGHWAY 119 N
BELFRY KY
41514-7417
US

IV. Provider business mailing address

26317 US HIGHWAY 119 N
BELFRY KY
41514-7417
US

V. Phone/Fax

Practice location:
  • Phone: 606-519-3543
  • Fax:
Mailing address:
  • Phone: 606-519-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number5465
License Number StateKY

VIII. Authorized Official

Name: DR. JARROD THACKER
Title or Position: OWNER
Credential: D.C.
Phone: 606-422-2515